Management Of Corneal Infiltrates After Corneal Cross-Linking: A Case Series

Published 2026 - 44th Congress of the ESCRS

Reference: POCOR175 | Type: Free paper | DOI: 10.82333/mgd5-k326

Authors: Younes Laarif ¹ , Dr rim elhachimi ² , salma hamidi* ² , soukayna ouadghiri ² , oussama bassim ² , noura achabak ² , aziza ouhadi ² , saad benchekroun ² , abdellah amazouzi ² , lalla ouafa ²

¹hsr,rabat,Morocco;hsr,rabat,Morocco, ²hsr,rabat,Morocco

Purpose

To describe the incidence, risk factors, clinical characteristics, and management outcomes of corneal infiltrates following epithelium-off corneal cross-linking (CXL) in patients with keratoconus.

Setting

This prospective descriptive study was conducted over a 1-year period (January 2023 to May 2024) in the hospital of speciality of rabat in morroco.

Methods

This study included 90 eyes that underwent epithelium-off corneal cross-linking using accelerated or sub-400 protocols, depending on corneal thickness, at the Department of Ophthalmology A, Specialty Hospital of Rabat. Preoperative parameters included age, maximum keratometry (Kmax), minimal pachymetry, and anterior and posterior elevation. Patients were monitored postoperatively for the occurrence of corneal infiltrates, clinical course, and treatment outcomes.

Results

The mean age of the overall cohort was 22.3 years, with a mean Kmax of 54.3 D and a mean minimal pachymetry of 438.6 µm. Eight of 90 eyes (8.9%) developed postoperative corneal infiltrates. In this subgroup, the mean age was 18.8 years, mean Kmax was 58 D, and mean minimal pachymetry was 421 µm. Six of eight patients had a history of severe allergic conjunctivitis. Identified risk factors included active allergic keratoconjunctivitis, thin cornea (<425 µm), and advanced keratoconus (Kmax >60 D). Seven infiltrates were considered sterile based on early onset, absence of fluorescein staining, and poor response to antibiotic therapy. All patients were treated with intensive topical corticosteroids, with favorable outcomes.

Conclusions

Corneal infiltrates following epithelium-off CXL are uncommon but clinically significant complications, predominantly sterile in origin. Young age, advanced keratoconus, thin corneas, and allergic keratoconjunctivitis appear to be major risk factors. Early diagnosis and prompt corticosteroid therapy result in favorable visual outcomes in most cases. Careful preoperative screening and optimal control of ocular surface inflammation are essential to minimize risk.