Severe microbial keratitis and associated perforation after corneal crosslinking for keratoconus

M Rana, A Lau, A Aralikatti, S Shah

Research output: Contribution to journalArticlepeer-review


PURPOSE: To report two cases of microbial keratitis with subsequent corneal perforation immediately following corneal collagen crosslinking (CXL).

METHODS: Retrospective case note review.

RESULTS: First case was a 19 year old female presented with staphylococcal corneal abscess 3 days post CXL procedure. Corneal perforation occurred during hospital admission and was successfully treated with corneal gluing. Microbial keratitis eventually resolved, with both topical and systemic antibiotics therapy, resulting in a vascularized corneal scar. Second case was an 18 year old male whom developed Methicillin Resistant Staphylococcus aureus (MRSA) corneal abscess 5 days after CXL procedure for progressive keratoconus. Corneal perforation occurred 48 h after presentation and patient underwent uneventful corneal gluing. Although infective keratitis was successfully treated with topical therapy, patient had visual outcome of count fingers due to scarring.

CONCLUSIONS: CXL has been widely used in the treatment of corneal ectatic conditions and complications, such as infective keratitis, are uncommon post procedure. We present two cases of severe microbial keratitis with subsequent corneal perforation within 7 days of CXL. The exact mechanism for the accelerated keratolysis process is unclear. Nonetheless, patients should be well-informed of such potentially devastating complication.

Original languageEnglish
Pages (from-to)134-137
Number of pages4
JournalContact Lens and Anterior Eye
Issue number2
Early online date28 Nov 2014
Publication statusPublished - Apr 2015


  • Adolescent
  • Adult
  • Corneal Perforation/diagnosis
  • Eye Infections, Bacterial/diagnosis
  • Female
  • Humans
  • Keratitis/diagnosis
  • Keratoconus/complications
  • Male
  • Photosensitizing Agents/therapeutic use
  • Riboflavin/therapeutic use
  • Staphylococcal Infections/diagnosis
  • Treatment Outcome
  • Ultraviolet Therapy/adverse effects


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