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Microbial keratitis after corneal collagen cross-linking in Sydney, Australia

Poster Details

First Author: P.Khoo AUSTRALIA

Co Author(s):    M. Cabrera-Aguas   S. Watson                 

Abstract Details


To report the clinical and microbiological profile of patients developing microbial keratitis post corneal collagen cross-linking (CXL) in a quaternary referral eye care centre.


Sydney Eye Hospital, New South Wales, Australia


A retrospective case-series including all patients diagnosed with microbial keratitis post CXL from 1st January 2012 to 31st December 2019. Patients were identified from hospital coding (ICD-10 coding) and pathology data. Data were extracted from medical records, this included demographics, pathology data, clinical features and patient outcomes. visual acuity was recorded and converted from Snellen to logarithm of the minimum angle of resolution (logMAR). Patient outcome was determined as good, moderate or poor, based on patient’s final visual acuity and ocular complications.


11 eyes from 10 patients with a mean age of 2911 years (range 16 – 48) were included. The median time to infection after CXL surgery was 4 days (IQR 3 – 83). The median initial and final VA at presentation was 1.3 logMAR (IQR 1 – 2.0) and 0.8 logMAR (IQR 0.6 – 1.2), respectively. The culture positivity rate was 92%, identifying 13 isolates, predominately made up of Coagulase-negative Staphylococcus (n=6, 50%) and Staphylococcus aureus (n=3, 25%). The median epithelial healing time was 30 days (IQR 15-53). 2 eyes required corneal transplantation due to non-healing epithelial defects.


Microbial keratitis post-CXL was predominately due to gram-positive bacteria with most patients having longer healing times and moderate to poor outcomes. For most of our patients, microbial keratitis occurred in the immediate post-operative period. We recommend clinicians stress the importance of their patients to avoid touching and rubbing their eyes, washing their hands before instilling eye drops and postoperative treatment compliance to avoid infections.

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