A Case Series of Infectious Keratitis After Corneal Cross-linking

PURPOSE: To present the 7-year experience of a tertiary eye hospital while exploring possible risk factors and incidence of infectious keratitis in patients undergoing standard corneal cross-linking (CXL).METHODS: This retrospective cohort study included patients with progressive keratoconus undergoing standard CXL in the Farabi Eye Hospital and all other patients who had undergone CXL in other facilities and were diagnosed as having infec-tious keratitis in the 7-year period of the study.RESULTS: Among the total of 4,863 eyes that underwent CXL, 6 eyes developed infectious keratitis, yielding an incidence rate of 0.12%. Additionally, 13 eyes from 10 patients with a CXL history in other facilities who developed infectious kera-titis were included. The mean age was 23.75 years, and 75% of patients were men and 25% were women. Gram-positive bacteria and Staphylococcus aureus were the most prevalent pathogens. Meibomian gland dysfunction, dry eye disease, or blepharitis were present in 12 patients. Medical treatment did not arrest the disease progress in 5 patients, which eventu-ally required cases to undergo keratoplasty.CONCLUSIONS: This study supports the need for proper pa-tient selection by using a comprehensive medical history. It also highlights the imperative role of rigorous patient edu-cation and follow-up, particularly in the first postoperative week. Finally, the study emphasizes aggressive early therapy for patients with suspicious findings.

Automated summary

This study presents the 7-year experience of a tertiary eye hospital with standard corneal cross-linking (CXL) and explores the risk factors and incidence of infectious keratitis. The results show that out of 4,863 eyes that underwent CXL, 6 eyes developed infectious keratitis, with an incidence rate of 0.12%. The study emphasizes the importance of proper patient selection, comprehensive medical history, rigorous patient education and follow-up, and aggressive early therapy for patients with suspicious findings.