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Aseptic corneal necrosis after corneal cross-linking

Poster Details

First Author: D.Chianello BRAZIL

Co Author(s):    M. Alves   A. Peroba   L. Patrao Buscacio   P. Contarini   P. Polisuk        

Abstract Details


To report a case of aseptic corneal necrosis as a complication after corneal cross-linking in a 13-year-old male patient with keratoconus.


Patient referred to Hospital Federal dos Servidores do Estado, Rio de Janeiro, RJ, Brazil, for urgency penetrating keratoplasty.


Descriptive study of a case report. The patient was submitted to corneal cross-linking performed according to Dresden protocol on the left eye, with mechanical removal of corneal epithelium. At the end of the treatment, topical moxifloxacin was administered and a bandage contact lens was placed. Patient was discharged with topical moxifloxacin, dexamethasone, ketorolac and lubricant eye drops.


Two days after corneal cross-linking on the left eye, the patient presented with severe pain, ocular hyperemia and decreased visual acuity. The slit-lamp exam showed extensive central corneal ulcer with microperforation. Corneal scrapings were performed. Cyanoacrylate adhesive and a therapeutic contact lens were applied. Treatment was made with topical antibiotic, oral valaciclovir and oral prednisolone. All corneal scrapings were negative. Penetrating keratoplasty was performed due to failure of clinical treatment. The diseased cornea was sent to culture and histopathological exam, that showed an unspecific chronic inflammatory process.


Corneal cross-linking is an effective procedure to halt the progression of ectatic diseases, including keratoconus. Although it has a low rate of complications, a serious one seems to be aseptic corneal necrosis. No previous reports of similar cases were found. Further studies are required to better understand the mechanisms involved. In the meantime, a strict follow-up is mandatory for prompt identification and treatment of complications.

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