Microbial Keratitis After Corneal Collagen Cross-Linking
Collagen cross-linking with riboflavin–UVA is a minimally invasive method. However, a refractive surgeon should be aware of its use on epithelial removal, which can be a predisposing factor for bacterial keratitis.
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Alberto Artola
Why Is This Case Relevant for the Refractive Surgeon?
Contents Why Is This Case Relevant for the Refractive Surgeon? .................................................................
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Case Background ...................................................
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Main Problem to Solve ..........................................
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Ancillary Tests ........................................................
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Surgical/Medical Intervention ..............................
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Outcome ..................................................................
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What to Learn from This Case .............................
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References ...............................................................
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A. Artola, MD, PhD Department of Surgery, Oftalmar Medimar Hospital Internacional, Universidad Miguel Hernández De Elche, Elche, Spain e-mail: [email protected]; [email protected]
Collagen cross-linking with riboflavin–UVA is a minimally invasive method. However, a refractive surgeon should be aware of its use on epithelial removal, which can be a predisposing factor for bacterial keratitis.
Case Background A 29-year-old woman was referred to our clinic in February 2008 for correction of progressive keratoconus. She did not have general health problems but was unable to wear contact lenses. Her best spectacle-corrected visual acuity (BSCVA) was 20/25 in the right eye (RE) and 20/32 in the left eye (LE), and her manifest refraction was −0.25 − 0.25 × 125 in the RE and −1.00 × 120 in the LE. Biomicroscopy results of the anterior segment were normal for the right eye; light Vogt striae were observed in the left eye. Intraocular pressure was 12 mmHg in each eye. Ophthalmoscopy revealed normal fundus in both eyes. Corneal thickness, measured with ultrasonic pachymetry (DGH-500 pachymeter, DGH Technology), was 450 and 430 μm in the right eye and left eye, respectively. Videokeratography showed a pattern consistent with keratoconus in both eyes (asymmetric bowtie with skewing of the radial axis above and below the horizontal meridian and inferonasal
J.L. Alió et al. (eds.), Difficult and Complicated Cases in Refractive Surgery, DOI 10.1007/978-3-642-55238-0_88, © Springer-Verlag Berlin Heidelberg 2015
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steepening). The videokeratography-derived indices keratometry (K) (central K-reading) and inferior–superior (I–S) dioptric asymmetry were 47 diopters (D) and 2.3 D, respectively, in the right eye and 51.2 D and the 4.1 D, respectively, in the left eye. Based on these data, Krumeich stage 1 keratoconus was diagnosed in the right eye and Krumeich stage 2 keratoconus was diagnosed in the left eye. The patient was scheduled for CXL with riboflavin–UVA light in the right eye and intracorneal ring segment implantation in the left eye. The risks of the surgery were fully explained to the patient in accordance with the Declaration of Helsinki. In March 2008, uneventful intracorneal ring segment implantation (Ferrara ring, Mediphacos) was performed in the left eye after a stromal tunne
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