Acute corneal melt and perforation - A possible complication after riboflavin/UV-A crosslinking (CXL) in keratoconus

Anne Tillmann; Daniel DanielKampik; Maria Borrelli; Maximilian Seidl; Johannes Menzel-Severing; Theo Günter Seiler; Gerd Geerling

doi:10.1016/j.ajoc.2022.101705

Acute corneal melt and perforation - A possible complication after riboflavin/UV-A crosslinking (CXL) in keratoconus

Am J Ophthalmol Case Rep. 2022 Sep 17:28:101705. doi: 10.1016/j.ajoc.2022.101705. eCollection 2022 Dec.

Authors

Anne Tillmann¹, Daniel DanielKampik², Maria Borrelli¹, Maximilian Seidl³, Johannes Menzel-Severing¹, Theo Günter Seiler^{1

4

5}, Gerd Geerling¹

Affiliations

¹ Department of Ophthalmology, University of Düsseldorf, Düsseldorf, Germany.
² Department of Ophthalmology, University of Würzburg, Würzburg, Germany.
³ Institute of Pathology, University of Düsseldorf, Düsseldorf, Germany.
⁴ Department of Ophthalmology, University of Bern, Bern, Switzerland.
⁵ Institute for Refractive and Ophthalmic Surgery (IROC), Zurich, Switzerland.

Abstract

Purpose: To report two cases of acute corneal melting and perforation requiring emergency penetrating keratoplasty after corneal crosslinking (CXL) in advanced keratoconus.

Observations: Case 1 was a 34 and case 2 was a 16-year old male, both with progressive keratoconus, who underwent CXL (Dresden protocol). After riboflavin imbibition, patients had a minimal pachymetry of 337 μm and 347 μm, and therefore required stromal swelling by hypoosmolar riboflavin resulting in pachymetries of 470 μm and 422 μm, prior to the 30 minute UV-irradiation with 3mW/cm². In case 1, on the 7th postoperative day a 4mm linear perforation occurred. Extensive post-hoc examinations revealed no infectious cause. In case 2, a corneal melting developed within 24 hours, from which Staphylococcus aureus was cultured.

Conclusions and importance: Acute corneal melting and perforation may occur after CXL. Dysfunctional collagen metabolism, atopia, thin preoperative pachymetry and the use of hypoosmolar substances may have initiated this complication in our cases.

Keywords: CXL; Complication; Corneal perforation; Crosslinking; Keratoconus; Penetrating keratoplasty.

Publication types

Case Reports