Case Report: Post-Epi-Off Crosslinking Corneal Necrosis: A Case Report
Published 2024 - 42nd Congress of the ESCRS
Reference: PO661 | Type: Poster | DOI: 10.82333/6jdx-y112
Authors: Boutaina Bousellam* 1 , Yasmine Bennani 1 , Bouhafra Youness 1 , Hibat Allah Eddaoui 1 , Soufiane Bencherif 1 , Salma Sefiani 1 , Rim Bennani Kamane 1 , Mounir Boufeloussen 1 , Aniss Regragui 1 , Nabiha Benchekroun 1 , Mohamed Belmekki 1
1Ophtalmology ,Hopital Cheikh Zaid ,Rabat,Morocco
Purpose
Among the treatment modalities for Keratoconus, corneal collagen cross-linking (CXL) is a promising treatment that may slow or stop the progression of KC and improve subjective and objective visual parameters by making biochemical and biomechanical changes in corneal tissue.
The principal goal of CXL is to stabilize the progression of diseases.
On the one hand, successful CXL can prevent the progression of KC and can even cause the ectatic cornea to regress. However, on the other hand, worsening in the ocular parameters can occur as a procedure complication.
Our study aims to report a case of corneal necrosis post-CXL Epi-Off, a procedure for treating keratoconus and managing this rare complication.
Setting
The patient was 19 years old and had a history of atopy. He presented with progressive keratoconus in both eyes, with minimal pachymetry of 416 and 405 um in the right eye and the left eye respectively, having been treated with simultaneous CXL in both eyes (Epi On in the right eye and Epi Off in the left eye), and complicated in the left eye by post-CXL corneal necrosis.
Methods
Post-CXL treatment consisted of NSAID eye drops, an antibiotic and corticoid combination which the patient did not take, and vitamin C.
Post-CXL ophthalmological examination on Day 2 showed acute corneal necrosis with light perception, and corneal OCT showed corneal thinning and necrotic changes in the left eye.
Results
A therapeutic corneal graft for architectural purposes was performed urgently.
An anatomical examination revealed a loss of corneal surface substance and the presence of fibrinoid necrosis.
The post-operative result showed preserved anatomical integrity, thinning of the graft, and improved visual acuity in the left eye.
Our case study aimed to highlight the complications of CXL Epi Off compared with CXL Epi On, as well as the methods used to manage these complications. Other factors of complication such as the use of NSAIDs were also discussed.
Conclusions
Corneal necrosis is a rare complication of CXL, favored by several factors such as allergic conjunctivitis, cornea thickness <400 µm, and use of NSAIDs. Choosing the right CXL protocol for the patient is essential for the safe management of keratoconus. This requires a precise study of the residual pachymetry and additional factors, to have a secure treatment of keratoconus. New protocol modifications have been used to help improve safety and efficacy in thinner corneas (Trans Epithelial CXL).
As CXL is gaining popularity, being aware of different approaches of CXL may help reduce complication rates and improve outcomes.