Wessely-type immune ring following collagen cross-linking

A woman in her early 20s with progressive keratoconus underwent corneal collagen cross-linking using the sub400 protocol. The central 5.5 mm of the epithelium was removed after the application of 20% alcohol. Topical riboflavin 0.1% was applied every 3 min for 30 min and then irradiated with UV-A light (irradiance of 3 mW/cm² for 16 min). At the end of the procedure, a therapeutic contact lens was placed and ofloxacin 0.3% (4 times daily), dexamethasone 0.1% (4 times daily) and lubricant (hourly) drops were prescribed.Two days after the procedure, the patient presented with a painless red eye. A 360° peripheral ring-like infiltrate was observed in the 5.5 mm zone, consistent with a sterile infiltrate. Dexamethasone 0.1% drops were prescribed and tapered for 1 month. Although the infiltrate gradually decreased under corticosteroid therapy, the patient's condition worsened after discontinuation of treatment. Treatment was resumed and complete recovery was observed 4 months later.