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Published on: November 12, 2015
Polymicrobial keratitis after accelerated corneal collagen cross-linking in keratoconus: Case reports and literature
Ying Lu1,2, Yewei Yin1,2, Tu Hu1,2
1159374Eye Center of Xiangya Hospital, Central South University, Changsha, China.
Purpose:
To report two cases of polymicrobial keratitis following corneal collagen cross-linking for keratoconus and to review the literature.
Methods:
Retrospective case note and literature review.
Results:
The first case involved a 27-year-old male who presented with amebic corneal ulcers 3 days after the collagen cross-linking procedure. Some gram-negative (gram-ve) cocci were found upon staining, and cysts were observed by confocal microscopy at 7 days after surgery. Acanthamoeba infection mixed with gram-ve organisms was diagnosed. In the second case, a 14-year male developed Staphylococcus aureus corneal infection with anterior chamber empyema 3 days after the collagen cross-linking procedure for keratoconus. Occasional gram-positive (gram + ve) cocci and gram-ve bacilli were observed under a microscope. The mixed keratitis in the two patients resolved after systemic and topical antibiotic therapy, but the infection ultimately resulted in corneal scarring. Follow-up keratoplasty was needed to improve vision acuity in both patients.
Conclusion:
Although ultraviolet irradiation and the reactive oxygen released by riboflavin during collagen cross-linking have bactericidal effects, a lack of a corneal epithelial barrier, bandage contact lens usage, perioperative hygiene, and an abnormal immune state are risk factors for infectious keratitis after collagen cross-linking. Perioperative management of collagen cross-linking is important to prevent infection.
Insights
Polymicrobial keratitis can occur after corneal collagen cross-linking for keratoconus. Careful perioperative management is crucial to prevent serious infections and vision loss.
Area of Science:
- Ophthalmology
- Microbiology
Background:
- Corneal collagen cross-linking (CXL) is a treatment for keratoconus.
- Infectious keratitis is a potential complication following CXL.
Observation:
- Two cases of polymicrobial keratitis after CXL are presented.
- Case 1: Amebic corneal ulcers with gram-negative organisms.
- Case 2: Staphylococcus aureus infection with anterior chamber empyema.
Findings:
- Both patients developed mixed bacterial and/or parasitic infections.
- Infections led to corneal scarring and required keratoplasty for visual recovery.
- Risk factors include epithelial defects, bandage contact lens use, and compromised immunity.
Implications:
- While CXL has antimicrobial properties, vigilance for infection is necessary.
- Optimizing perioperative hygiene and patient selection can mitigate risks.
- Prompt diagnosis and treatment are essential to preserve vision.
