June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
Infectious and sterile keratitis after corneal crosslinking for keratoconus
Author Affiliations & Notes
  • Yurico Lopez
    Cornea, Instituto de Oftalmologia Fundacion Conde de Valenciana IAP, Mexico City, Mexico City, Mexico
  • Jesus Guerrero
    Cornea, Instituto de Oftalmologia Fundacion Conde de Valenciana IAP, Mexico City, Mexico City, Mexico
  • Arturo Ramírez-Miranda
    Cornea, Instituto de Oftalmologia Fundacion Conde de Valenciana IAP, Mexico City, Mexico City, Mexico
  • Alejandro Navas-Perez
    Cornea, Instituto de Oftalmologia Fundacion Conde de Valenciana IAP, Mexico City, Mexico City, Mexico
  • Víctor Manuel Bautista- de Lucio
    Instituto de Oftalmologia Fundacion Conde de Valenciana IAP, Mexico City, Mexico City, Mexico
  • Enrique O Graue-Hernandez
    Cornea, Instituto de Oftalmologia Fundacion Conde de Valenciana IAP, Mexico City, Mexico City, Mexico
  • Footnotes
    Commercial Relationships   Yurico Lopez None; Jesus Guerrero None; Arturo Ramírez-Miranda None; Alejandro Navas-Perez None; Víctor Bautista- de Lucio None; Enrique Graue-Hernandez None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 2418 – A0221. doi:
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      Yurico Lopez, Jesus Guerrero, Arturo Ramírez-Miranda, Alejandro Navas-Perez, Víctor Manuel Bautista- de Lucio, Enrique O Graue-Hernandez; Infectious and sterile keratitis after corneal crosslinking for keratoconus. Invest. Ophthalmol. Vis. Sci. 2022;63(7):2418 – A0221.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Collagen crosslinking (CXL) is a proven effective treatment for halting the progression of keratoconus, with a low rate of complications including infection. To recognize risk factors is fundamental. We describe infectious keratitis prevalence and findings after accelerated (Epi-Off) and transepithelial (Epi-On) CXL in a third-level center.

Methods : Descriptive case series of patients who were treated with Epi-Off or Epi-On CXL for progressive keratoconus. We retrospectively reviewed all clinical records for a period of 10 years (2009-2018) of patients who underwent CXL for keratoconus. Keratitis patients were noted and analyzed. Based on clinical findings, they were classified either as sterile or infectious. Microbial cultures and antibiotic susceptibility were recorded when available. We recorded the following features: common risk factors, treatment regimen, detected microorganisms, antibiotic susceptibility, and clinical outcomes.

Results : From 1082 eyes reviewed, a total of 7 eyes developed keratitis (0.64%). Four of the seven cases presented as infectious keratitis (57.14%) and three as sterile keratitis (42.85%). Epi-On was performed in corneas with thinnest corneal point less than 380 um. Two cases developed keratitis in this group (28.57%). The mean time of presentation was 10.8 days postoperatively. The most common pathogen was Staphylococcus aureus (50%) and Staphylococcus epidermidis (75%). One case reported Pseudomonas mendocina culture growth. Preoperative mean best corrected visual acuity (BCVA) was 0.42 (logMAR), mean BCVA at resolution was 0.65 (logMAR). Most common posterior complications were corneal leucomas (71.4%). The use of steroids and soft bandage contact lenses in the immediate postoperative period were reported in 100% of the patients. Five cases were covered with antibiotic therapy in this period (tobramycin 42.85%, ciprofloxacin 14.2%, moxifloxacin 14.2%). History of atopic disease was present in 85.71% of all the cases.

Conclusions : The overall frequency of infectious keratitis after CXL remains low, but the implications can be deleterious. History of atopia could be associated with disturbance of the immunological barriers, predisposing to keratitis. The importance of judicious use of steroids, promptly identification of the condition and a cultured directed antimicrobial therapy when possible, as well as more frecuent check up visits may be highly valuable in these patients.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

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