Infectious Keratitis May Be Rare, Challenging Complication Following Corneal Crosslinking

Infectious keratitis may be a rare but potentially challenging complication following corneal crosslinking (CXL), according to a study published in the Journal of Refractive Surgery. This research highlights the importance of proper patient selection, patient education and follow-up, particularly in the first postoperative week after CXL. The report also emphasizes aggressive early therapy for patients who develop infectious keratitis. 

Researchers conducted a retrospective cohort study that included patients with progressive keratoconus undergoing standard CXL at the Farabi Eye Hospital between April 2015 and April 2021. The study also included all other patients who underwent CXL in other facilities and were diagnosed as having infectious keratitis in the 7-year period of the study.

Of the 4863 eyes that underwent CXL, 6 eyes from 6 patients developed infectious keratitis, resulting in an incidence rate of 0.12%. In addition, 13 eyes from 10 patients with a history of CXL in other facilities who developed infectious keratitis were included.

Among patients diagnosed with infectious keratitis after CXL, the mean age was 23.75 years, and 75% of patients were men and 25% were women. The most prevalent pathogens were gram-positive bacteria and Staphylococcus aureus. 

A total of 12 patients with infectious keratitis after CXL had meibomian gland dysfunction, dry eye disease, or blepharitis. 

Medical treatment did not resolve the complication in 5 patients, which eventually required patients to undergo keratoplasty.

“Because there is no conclusive evidence to enable us to identify patients who would experience the fulminant course of keratitis, leading to perforation, it is crucial to pay attention to the slightest signs pointing toward infection and start medical therapy early and aggressively,” according to the researchers. “This study emphasizes the need for proper patient selection and obtaining a thorough medical history and highlights the role of meticulous patient education and follow-up, particularly in the first postoperative week.”

Study limitations include its retrospective design, a bias toward over-diagnosis and an increased rate of keratitis, failure to assess dry eye disease and meibomian gland dysfunction prevalence in all patients undergoing CXL, and specific data for the procedure type in some patients who underwent CXL in other centers were unavailable.