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MRSA endophthalmitis after corneal collagen cross-linking procedure in a patient with atopic dermatitis: first report and review of the literature

Poster Details

First Author: A.Agresta ITALY

Co Author(s):    R. Fasciani   L. Mosca   A. Caristia   S. Ambrogio   A. Caporossi  

Abstract Details


To report a case of Methicillin Resistent Staphylococcus Aureus (MRSA) endophthalmitis after UVA-riboflavin corneal collagen cross-linking procedure and to perform a systematic review of Literature of MRSA corneal infections and therapy


Observational case report and MEDLINE review of the medical literature on corneal collagen cross-linking infectious complications


A 22 years old man, affected by bilateral evolutive keratoconus and treated with UVA-riboflavin cross-linking in right eye, presented a rapidly progressing corneal abscess and cyclitis in the treated eye five days after surgery. The case was hospitalized and treated at the Ophthalmology Department of the Catholic University of Sacro Cuore in Rome, and a review for risk factors, prophylaxis, culture results, early therapy, clinical course and outcome was made


A first broad-spectrum local and systemic antibiotic therapy was administered. After, a vitreous inflammatory reaction was quickly counter with both subconjunctival and intravitreal injections of vancomicin 1mg/ml. Cultures isolated a MRSA with a strong antibiotics resistance, scarcely susceptible to vancomycin and linezolid, and a little bit more sensitive to daptomycin, tetracycline, teicoplanin and clindamycin. Therapy was properly modified and targeted according to the results of sensitivity test: intravenous linezolid and daptomycin, renforced vancomycin eye drops and tetracycline ophthalmic ointment were administered. Since there were no signs of clinical worsening, daptomycin intravitreal injection 200 ╬╝gr/ml was not performed, although its clinical use was planned. The intravitreal reaction extinguished without sequelae to inner ocular structures but a severe impairment of the whole cornea was unavoidable


Although the riboflavin/UVA corneal cross-linking procedure is considered a safe procedure and is extremely useful in halting keratoconus progression, it is not devoid of infectious complications, even serious ones, related to known risk factors such as atopic dermatitis or poor hygiene compliance by the patient in the postoperative period. Atopic dermatitis is a relative common disease in keratoconus patients. MRSA colonizations is frequently detected in atopic dermatitis. Medical history, especially for atopic and dermatologic conditions, should be carefully perform before surgery to identify infective risk factors. Preoperative isolation of bacteria from the conjunctival sac and eyelid margin with sensitivity test should also be performed before cross-linking surgery to avoid severe complications FINANCIAL INTEREST: NONE

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