Case Report:Corneal Ring Abscess Following Corneal Collagen Crosslinking With Riboflavin: A Treatable Tragedy?

Corneal Collagen cross linking has been proven to be a safe long term  prophylactic treatment treatment for cases of keratoconus .The incidence of infection to occur  in such procedure is very rare(low as 0.12%) in large studies.

In this case study the aim is to reporet a case of cornel ring abcess that occured after cornel collagen crosslinking for treatment of keratoconus

A 28 year old female patient came to the clinic seeking treatment for her keratoconus condition.She had bilateral Keratoconus grade III right eye and grade II left eye(ABCD Classaification).BVCA was 0.4 right eye and 0.3 left eye LogMAR scale.

Full ophthalmological examination was conducted, and upon which  the decision was taken to perform epioff corneal collagen cross linking with riboflavin for both eyes simultaneously to prevent further progression of her condition.

The technique was   conducted starting with riboflavin (vitamin (B12}) solution is applied to the cornea to act as a photosensitizer for 10 minutes. Avedro systems use specific riboflavin formulations for this purpose fot the Ultraviolet light exposure.The cornea is then exposed to a higher-intensity Ultraviolet light for a shorter period. In a standard accelerated protocol, this is typically 18 mW/cm for 8 minutes.Photochemical reaction: The riboflavin absorbs the UV light, triggering a photochemical reaction that creates new bonds between the collagen fibers in the cornea.Strengthened cornea: This reaction increases the cornea's biomechanical strength and rigidity, which helps to halt or slow the progression of corneal thinning disorders.

The patient was seen next day with no significant findings, then late night the patient contacted us complaining of severe pain and redness in her right eye.First thing to come in our mind as that the bandage contact lens may have fallen,. The patient was seen same night ,there was an unexpected surprise: a 6 mm diameter  corneal ring abcess in her right eye with severe conjunctival congestion.

Conjunctival swab was taken for culture and sensitivity. PCR was done for the possibility of acanthamoeba kerartitis, Immediate intensive treatment was initiated of systemic antibiotics, fortified antibiotics,  topical pain killers and decongestants.

Despite its rarity, corneal infections following corneal collagen cross linking with riboflavin can happen.Keeping sterile conditions is a must to prevent, and but it can also occur despite all measures taken.Proper management after detecting the causative organism can finish the tragedy and prevent more severe consequences like corneal melting or perforation.