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Acute corneal melt and perforation – A possible complication after riboflavin/UV-A crosslinking (CXL) in keratoconus
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...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9519437/ https://www.ncbi.nlm.nih.gov/pubmed/36187442 http://dx.doi.org/10.1016/j.ajoc.2022.101705 |
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author | Tillmann, Anne DanielKampik, Daniel Borrelli, Maria Seidl, Maximilian Menzel-Severing, Johannes Seiler, Theo Günter Geerling, Gerd |
author_facet | Tillmann, Anne DanielKampik, Daniel Borrelli, Maria Seidl, Maximilian Menzel-Severing, Johannes Seiler, Theo Günter Geerling, Gerd |
author_sort | Tillmann, Anne |
collection | PubMed |
description | 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/cm(2). 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. |
format | Online Article Text |
id | pubmed-9519437 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-95194372022-09-30 Acute corneal melt and perforation – A possible complication after riboflavin/UV-A crosslinking (CXL) in keratoconus Tillmann, Anne DanielKampik, Daniel Borrelli, Maria Seidl, Maximilian Menzel-Severing, Johannes Seiler, Theo Günter Geerling, Gerd Am J Ophthalmol Case Rep Case Report 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/cm(2). 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. Elsevier 2022-09-17 /pmc/articles/PMC9519437/ /pubmed/36187442 http://dx.doi.org/10.1016/j.ajoc.2022.101705 Text en © 2022 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Case Report Tillmann, Anne DanielKampik, Daniel Borrelli, Maria Seidl, Maximilian Menzel-Severing, Johannes Seiler, Theo Günter Geerling, Gerd Acute corneal melt and perforation – A possible complication after riboflavin/UV-A crosslinking (CXL) in keratoconus |
title | Acute corneal melt and perforation – A possible complication after riboflavin/UV-A crosslinking (CXL) in keratoconus |
title_full | Acute corneal melt and perforation – A possible complication after riboflavin/UV-A crosslinking (CXL) in keratoconus |
title_fullStr | Acute corneal melt and perforation – A possible complication after riboflavin/UV-A crosslinking (CXL) in keratoconus |
title_full_unstemmed | Acute corneal melt and perforation – A possible complication after riboflavin/UV-A crosslinking (CXL) in keratoconus |
title_short | Acute corneal melt and perforation – A possible complication after riboflavin/UV-A crosslinking (CXL) in keratoconus |
title_sort | acute corneal melt and perforation – a possible complication after riboflavin/uv-a crosslinking (cxl) in keratoconus |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9519437/ https://www.ncbi.nlm.nih.gov/pubmed/36187442 http://dx.doi.org/10.1016/j.ajoc.2022.101705 |
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