Incidence and Outcomes of Infectious Keratitis After Corneal Collagen Cross-Linking Over 10 Years From a Tertiary...

The purpose of this study was to report the incidence and outcomes of infectious keratitis after corneal collagen cross-linking (CXL) over 10 years in South India.

Patients who underwent CXL for progressive keratoconus between January 2011 and December 2020 and those with infectious keratitis were identified from an electronic database system. The clinical and microbiological profiles of those affected were extracted from the case files and included in the analysis, whereas viral keratitis was excluded.

Eleven eyes with post-CXL infectious keratitis were identified, with 3842 CXL procedures (0.21%) occurring in-house, while 3 were referred from outside. The mean age of the patients was 21.8 ± 7.8 years, and 7 (64%) were male. Six eyes (54%) had conventional isotonic CXL, whereas 5 had hypotonic CXL when pachymetry was <400 μm. Six eyes (54%) presented with hypopyon at a median of 3 days after CXL. Culture of the corneal scrapings grew methicillin-sensitive Staphylococcus aureus in 4 patients, methicillin-sensitive Staphylococcus epidermidis in 2, Aspergillus fumigatus in 1, Aspergillus flavus in 1, Haemophilus parainfluenzae in 1, and no organisms in 2 patients. Almost all the isolates were resistant to ciprofloxacin and other fluoroquinolones. The majority of eyes responded well to intensive topical antibiotics guided by antibiograms and regained 6/18 vision (median). Therapeutic keratoplasty was needed in 2 eyes while cyanoacrylate glue was needed in another 2 eyes.

Post-CXL infections are rare, most frequently caused by antibiotic-resistant commensals, and resemble the clinical spectrum and outcomes of non-CXL-related infectious keratitis in most cases.