CORNEAL MELT FOLLOWING EPITHELIUM-OFF CROSSLINKING: ABOUT A NOVEL CASE.

To report a rare and vision-threatening complication of Epithelium-off ( Epi-off) Crosslinking(CXL)

Cheikh Zaid International Hospital, Eye center, Rabat, MOROCCO

A descriptive case study of a 22-year-old patient referred for tectonic corneal graft (OD) following an acute corneal melt. The patient had a history of progressive bilateral keratoconus indicating a CXL.  He underwent an uneventful Epi-Off  CXL on a cornea with a Minimal Pachymetry of 416 µm, and an Epithelial Thickness of 62 µm.  Irradiation was performed with an intensity of 30mW/cm2, an energy of 5.4J, and a 3 min exposure time. The patient was discharged with 2 days Indometacin drops, Oral Vitamin C and analgesics. He was also prescribed Loteprednol Etabonate 0.5% and Tobramycin 0.3% , but did not use it. The patient developed a corneal melt two days following the CXL requiring an urgent management

Treatment consisted of a mid-sized 9mm Penetrating Keratoplasty for tectonic purposes. Post-operative course was simple for a follow-up time period of 8 months.  Anatomopathological examination revealed the presence of a fibrinoid necrosis extending beyond the corneal stroma. Bacteriological and immunological work-up returned negative.

Management of thin corneas is a challenge for the ophthalmologist due to the potential sight-threatening complications. Crosslinking is currently evolving towards a patient-tailored treatment strategy. To this aim, the elaboration of clinical and technical check-lists for thin corneas would be helpful to prevent the onset of such complications.