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...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2022-12-01
|
| Series: | American Journal of Ophthalmology Case Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2451993622004510 |
| _version_ | 1811311127115595776 |
|---|---|
| author | Anne Tillmann Daniel DanielKampik Maria Borrelli Maximilian Seidl Johannes Menzel-Severing Theo Günter Seiler Gerd Geerling |
| author_facet | Anne Tillmann Daniel DanielKampik Maria Borrelli Maximilian Seidl Johannes Menzel-Severing Theo Günter Seiler Gerd Geerling |
| author_sort | Anne Tillmann |
| collection | DOAJ |
| 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/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. |
| first_indexed | 2024-04-13T10:12:16Z |
| format | Article |
| id | doaj.art-b59ab053fbe64d8783fb195890074330 |
| institution | Directory Open Access Journal |
| issn | 2451-9936 |
| language | English |
| last_indexed | 2024-04-13T10:12:16Z |
| publishDate | 2022-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Journal of Ophthalmology Case Reports |
| spelling | doaj.art-b59ab053fbe64d8783fb1958900743302022-12-22T02:50:52ZengElsevierAmerican Journal of Ophthalmology Case Reports2451-99362022-12-0128101705Acute corneal melt and perforation – A possible complication after riboflavin/UV-A crosslinking (CXL) in keratoconusAnne Tillmann0Daniel DanielKampik1Maria Borrelli2Maximilian Seidl3Johannes Menzel-Severing4Theo Günter Seiler5Gerd Geerling6Department of Ophthalmology, University of Düsseldorf, Düsseldorf, Germany; Corresponding author. University Hospital Duesseldorf, Department of Ophthalmology, Moorenstraße 5, D-40225, Duesseldorf, Germany.Department of Ophthalmology, University of Würzburg, Würzburg, GermanyDepartment of Ophthalmology, University of Düsseldorf, Düsseldorf, GermanyInstitute of Pathology, University of Düsseldorf, Düsseldorf, GermanyDepartment of Ophthalmology, University of Düsseldorf, Düsseldorf, GermanyDepartment of Ophthalmology, University of Düsseldorf, Düsseldorf, Germany; Department of Ophthalmology, University of Bern, Bern, Switzerland; Institute for Refractive and Ophthalmic Surgery (IROC), Zurich, SwitzerlandDepartment of Ophthalmology, University of Düsseldorf, Düsseldorf, GermanyPurpose: 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.http://www.sciencedirect.com/science/article/pii/S2451993622004510KeratoconusCXLCrosslinkingCorneal perforationComplicationPenetrating keratoplasty |
| spellingShingle | Anne Tillmann Daniel DanielKampik Maria Borrelli Maximilian Seidl Johannes Menzel-Severing Theo Günter Seiler Gerd Geerling Acute corneal melt and perforation – A possible complication after riboflavin/UV-A crosslinking (CXL) in keratoconus American Journal of Ophthalmology Case Reports Keratoconus CXL Crosslinking Corneal perforation Complication Penetrating keratoplasty |
| 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 | Keratoconus CXL Crosslinking Corneal perforation Complication Penetrating keratoplasty |
| url | http://www.sciencedirect.com/science/article/pii/S2451993622004510 |
| work_keys_str_mv | AT annetillmann acutecornealmeltandperforationapossiblecomplicationafterriboflavinuvacrosslinkingcxlinkeratoconus AT danieldanielkampik acutecornealmeltandperforationapossiblecomplicationafterriboflavinuvacrosslinkingcxlinkeratoconus AT mariaborrelli acutecornealmeltandperforationapossiblecomplicationafterriboflavinuvacrosslinkingcxlinkeratoconus AT maximilianseidl acutecornealmeltandperforationapossiblecomplicationafterriboflavinuvacrosslinkingcxlinkeratoconus AT johannesmenzelsevering acutecornealmeltandperforationapossiblecomplicationafterriboflavinuvacrosslinkingcxlinkeratoconus AT theogunterseiler acutecornealmeltandperforationapossiblecomplicationafterriboflavinuvacrosslinkingcxlinkeratoconus AT gerdgeerling acutecornealmeltandperforationapossiblecomplicationafterriboflavinuvacrosslinkingcxlinkeratoconus |