Infiltrative Keratitis Following Collagen Cross Linking

To analyse the risk factors, clinical features, visual outcomes and in-vivo imaging characteristics in cases of keratoconus developing keratitis following accelerated collagen cross linking (CXL).

Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, Delhi

A retrospective observational case series at a tertiary eye centre in India evaluating eyes that underwent accelerated CXL  from January 2021 to July 2024. 

Of 723 eyes undergoing CXL, 13 eyes developed infectious keratitis (1.79%). The relative risk of developing infiltrates in cases < 16 years was 2.38 and in cases with history of vernal keratoconjunctivitis was 0.7. The mean duration from onset of symptoms to presentation was 2.7 ± 1.5 days. The median area of epithelial defect was 12 mm² and average resolution time was 18.4 ± 12.9 days. The most commonly isolated microorganism was CoNS.The resistance to fourth generation fluoroquinolones was observed in three of five culture positive cases (60%). Scheimpflug imaging helped to identify three patterns of keratometric changes in these eyes following infectious keratitis. 

Infectious keratitis following accelerated CXL is a rare clinical entity. Early presentation, timely management including use of topical steroids are associated with good visual outcomes.