Official ESCRS | European Society of Cataract & Refractive Surgeons


Risk of microbial keratitis following corneal collagen cross-linking for corneal ectasia

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Session Details

Session Title: Ocular Pathology/Education & Training

Session Date/Time: Tuesday 17/09/2019 | 14:00-16:00

Paper Time: 14:06

Venue: Free Paper Forum: Podium 4

First Author: : M.Ahad SAUDI ARABIA

Co Author(s): :    M. Al Amro   A. Al Qarni   S. Al Swailem                       

Abstract Details


Keratoconus is a bilateral, non-inflammatory, progressive corneal ectasia that mostly develops in younger age groups. Corneal crosslinking (CXL) is the only proven treatment that can delay or halt the progression of keratoconus. The treatment is however not without risks particularly in an age group where compliance has always been a concern. The purpose of this study was to elucidate the risk of microbial keratitis in patients undergoing CXL for progressive ectasia.


The study was conducted in King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. The hospital is a tertiary care and a national referral centre for the treatment of eye diseases and caters the whole kingdom of Saudi Arabia


Medical records of all CXL performed between January 2010 and October 2016 were reviewed and cases that developed microbial keratitis were identified. Parameters analyzed were demographic details, time of onset of keratitis, treatment received, organism isolated and visual outcome. All patients underwent epithelium-off accelerated-CXL and at the end of procedure, a bandage contact lens was applied. Postoperatively, all patients were prescribed topical antibiotics for 1 week and steroids for 2-3 months All cases were followed up as per local standard guidelines. If there was any suspicion of keratitis on follow-up, then a standard protocol for managing microbial keratitis was followed.


Out of total of 1300 CXL procedures, 16 (1.2%) cases developed microbial keratitis. Median age of patients was 23 years, eleven males and five females. Pre-operative mean corneal-thickness at thinnest point was 471 microns(range:400-540) and mean steepest-central-keratometric reading was 42.6 diopters (range:42.6-58.9 D). The median time from the procedure to presentation was 3 days (range:1–4). At presentation the infiltrate size varied from 2-7 mm. Microbial cultures were positive in ten cases (62.5%) and all were bacterial. All cases resolved with topical antibiotics but ended up with dense scarring.


The incidence of microbial keratitis after CXL appears to be around 1%. Although all cases healed with topical antibiotics but visual acuity was severely limited due to corneal scarring. The higher incidence of infection observed in our series can be largely attributed to the poor compliance and postoperative care by the patients

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