Keratopathy After Cross-linking for Keratoconus

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Purpose:To report 2 cases of keratopathy after uneventful cross-linking procedures for grade 3 keratoconus.Methods:Two patients (21 and 11 years old) with grade 3 keratoconus underwent uneventful cross-linking in 1 eye. In both patients, multiple peripheral stromal precipitates, which extended centripetally, were observed 48 hours after the procedure. Sample cultures were negative for bacteria, fungi, and parasites.Results:Cornea infiltrates slowly resolved after combined topical antibiotic/antifungal/povidone/steroids treatment. Final best spectacle-corrected visual acuity was 20/25 for patient 1, after uneventful bilateral toric intraocular contact lens (ICL) (Staar Surgical) implantation, but faint and paracentral scarring persisted. Final best-corrected visual acuity was 20/25 for patient 2 with gas-permeable contact lens wear, despite stromal scarring.Conclusions:Cross-linking associated with sterile keratitis is an unusual entity of unknown etiology, which can lead to stromal scarring.

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