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Acute endothelitis early after corneal collagen cross-linking with riboflavin and ultraviolet-A

Poster Details

First Author: M.Gumus TURKEY

Co Author(s):                  

Abstract Details


To present an acute endothelitis occurred early after corneal cross-linking (CXL) for progressive keratectasia and to discuss possible risk factors, causes and other complications.


Erciyes University School of Medicine, Department of Ophthalmology, Kayseri, Turkey


A 24-year old woman with bilateral keratoconus underwent a corneal deepithelization and subsequently CXL in the right eye, which was performed with the application of 0.1% riboflavin with 20% dextran, and exposure to UVA light (370 nm, 2.9–3.1 mW/cm2) for 30 minutes. After the first step, corneal thickness was checked and 0.1% hypotonic riboflavin solution was applied to swell cornea to at least 400 microns. A therapeutic contact lens (PureVision 2 HD, Bausch & Lomb) was placed after the surgery. The surgery was uneventful, and postoperatively, the patient received 0.5% topical moxifloxacin (4x/day) (Vigamox, Alcon Laboratories, Inc., Fort Worth, TX, US) and preservative free artificial tears (6x/day) (Refresh, Allergan, Inc, Irvine, CA, US). After the epithelial healing, it was planned to start topical 0.5% loteprednol etabonate ophthalmic suspension (Lotemax, Bausch & Lomb).


Postoperatively, while the healing process was going completely uneventful in the first two days, the patient presented significant hyperemia and photophobia on the third day. On biomicroscopy, sterile ring-shaped endothelial infiltrates and localized corneal edema were observed in the inferior paracentral location of the cornea. The patient had no blepharitis, meibomitis, or medical history of systemic illness or ocular inflammatory disorders. Sterile endothelitis was diagnosed, the therapeutic contact lens was removed, and 1% prednisolone acetate suspension (Predforte; Allergan, Inc, Irvine, CA, US) was started every hour in addition to hypertonic ophthalmic solution every 3 hours. After this intensive corticosteroid treatment, the infiltrates had improved and completely resolved after one week.


Even though the CXL seems to be a relatively safe procedure, it has been reported that some undesirable complications might be seen following the procedure. This is the first reported sterile endothelitis occurred after the uneventful CXL. Hypothetically, this very rare complication may occur as a result of phototoxic effect of UV-A transmission on the corneal endothelium or inflammatory response to the surgical trauma, solutions used throughout the procedure, or any foreign body. FINANCIAL DISCLOSURE?: No

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