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Published on: November 12, 2015
Bacterial keratitis early after corneal crosslinking with riboflavin and ultraviolet-A
Matthias Pollhammer1, Claus Cursiefen
1Department of Ophthalmology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany. matthias.pollhammer@uk-erlangen.de
Abstract:
We report a case of bacterial keratitis 3 days after corneal crosslinking for keratoconus. The patient complained of increasing pain and redness combined with blurred vision in the treated eye starting on the first postoperative day. Clinical examination showed multiple stromal infiltrations and moderate anterior chamber inflammation. Corneal scraping revealed an Escherichia coli infection, which was successfully treated with fortified tobramycin and cephazolin eyedrops for several weeks. This is the first report of a case of rare postoperative complication resulted in an avascularized corneal scar and permanent reduction of the visual acuity.
Insights
Bacterial keratitis caused by Escherichia coli occurred 3 days after corneal crosslinking for keratoconus. Prompt antibiotic treatment led to successful recovery, but resulted in a corneal scar and reduced vision.
Area of Science:
- Ophthalmology
- Microbiology
- Corneal Surgery
Background:
- Corneal crosslinking (CXL) is a standard procedure for treating progressive keratoconus.
- Postoperative bacterial keratitis is a rare but serious complication following CXL.
- Early diagnosis and prompt treatment are crucial for managing microbial keratitis.
Observation:
- A patient developed severe symptoms including pain, redness, and blurred vision in the treated eye on the first postoperative day after CXL.
- Clinical examination revealed significant corneal stromal infiltrations and anterior chamber inflammation.
- Corneal scraping identified an infection with Escherichia coli.
Findings:
- The patient was successfully treated with fortified tobramycin and cephazolin eyedrops over several weeks.
- Despite successful infection treatment, the complication resulted in an avascularized corneal scar.
- The avascularized scar led to a permanent reduction in the patient's visual acuity.
Implications:
- This case highlights the importance of vigilance for infectious complications after CXL.
- Escherichia coli can cause severe bacterial keratitis post-CXL, necessitating aggressive antimicrobial therapy.
- Even with successful treatment, infectious keratitis can lead to long-term visual impairment, underscoring the need for preventive strategies and careful patient monitoring.
