Infectious keratitis after corneal crosslinking: systematic review

Corneal crosslinking is a U.S. Food and Drug Administration-- approved therapy to stiffen the cornea and prevent progression of corneal ectasia in patients with keratoconus. The standard procedure involves removal of the corneal epithelium (epithelial-off) prior to treatment. Variations to the standard procedure include accelerated crosslinking and transepithelial procedures. This study reviewed what is known regarding the risk for infection after epithelial-off cross-linking, the spectrum of pathogens, and clinical outcomes. 26 publications were identified. All eyes were fit with a bandage contact lens postoperatively. Available data indicate that the overall frequency of infectious keratitis after epithelium-off crosslinking is low. Bacterial infections are the most common, with a mean time of presentation of 4.8 days postoperatively. The use of steroids and bandage contact lenses in the immediate postoperative period and/or a history of atopic or herpetic disease were associated with infection. These patients require intense postoperative care with prophylactic antiviral therapy when appropriate.

Automated summary

Corneal crosslinking is an approved therapy to prevent progression of corneal ectasia in keratoconus patients. The risk of infection after epithelial-off crosslinking is low, with bacterial infections being the most common. Close monitoring and immediate postoperative care are important for these patients.