A Case Of Collagen Cross-Linking In A Patient With Acute Keratoconus.

Report a case of acute keratoconus and the use of а cross-linking technique.

Acute corneal hydrops is a formidable complication of progressive keratoconus. There are numerous techniques surgical techniques for treating acute keratoconus but none of them is optimal. 
The literature describes very rare cases of the use of cross-linking in acute keratoconus.
Carrying out other surgical treatment methods and the inability to consult the patient in a specialized center forced us to make a decision to perform cross-linking (CXL). 

 46-year-old male consulted in May 2022. Keratoconus had been diagnosed for the first time when he was hospitalized. 
    A slit-lamp examination of the left eye showed lack of corneal sensitivity, stromal and epithelial microcystic edema, intrastromal cyst. Uncorrected visual acuity (UCVA) was 0.04. Spectacles did not improve the patient's vision. Ectasia was established using anterior segment OCT (ASOCT). The thickness of the cornea in the thinnest place was 415 µm, the greatest thickness reached more than 1300 µm. Refractometry and keratometry were not determined due to corneal edema. Due to conservative treatment, the swelling slightly decreased.
    We suggested performing Epi-On CXL 2 weeks after conservative treatment. After local anesthesia, Riboflavin (Peschke TE) was instilled every 2 min for 30 min. The cornea was irradiated with UV-A light using 3 mW/cm2 for 30 min with soaking of riboflavin every 5 min, total energy of 5.4 j/cm2. The cornea was covered with contact lens for 1 week
    In 2 days after the surgery, the thickness of the cornea in the thinnest place was 69 µm, a cyst-like cavity was formed. The next ASOCT examination 10 days later showed a corneal thickness of 935 µm, 143 µm at the thinnest point. After another 14 days, the total thickness of the cornea was 624-726 µm. A month later, the depth of the demarcation line was 404 µm, the thickness of the cornea was 480 µm in the area of hydrops.
    There is no swelling of the cornea, a scar has formed.

Epi-On CXL can be offered as one of the treatment options, as it is a safe and an effective method to reduce corneal edema in acute Keratoconus.