Significant visual increase following infectious keratitis after collagen cross-linking

Area of Science:

• Ophthalmology
• Corneal Surgery
• Infectious Diseases

Background:

• Progressive keratoconus is often treated with corneal collagen cross-linking (CXL) to strengthen the cornea.
• Complications such as infectious keratitis can occur post-CXL, potentially leading to corneal scarring.

Observation:

• A patient developed infectious keratitis in the left cornea three days after CXL for keratoconus.
• The infection resulted in a paracentral corneal scar despite antibiotic treatment.

Findings:

• High-resolution imaging revealed significant flattening of the anterior corneal curvature (>11.00 diopters) due to the scar.
• This flattening led to a notable improvement in corrected distance visual acuity by five lines.

Implications:

• Corneal remodeling, even secondary to infection and scarring, can homogenize the corneal surface.
• In irregular corneas like those with keratoconus, scar-induced flattening may enhance visual acuity by outweighing aberrations and light scatter.