Infectious Crystalline Keratopathy After Corneal Cross-linking

Abstract

To report a rare case of infectious keratitis after collagen cross-linking (CXL) for keratoconus. A 20-year-old male patient underwent CXL for keratoconus in his right eye. Four weeks after the procedure, he reported blurred vision and redness with increasing pain in the treated eye. Ophthalmic examination revealed a corneal epithelial defect with corneal infiltrates that exhibited branching needle-like opacities. The patient was diagnosed with infectious crystalline keratopathy (ICK). Corneal scrapings and culture indicated the presence of Streptococcus sanguinis. The patient was successfully treated with fortified vancomycin and ceftazidime over several weeks. ICK is a potential post-operative complication of CXL that can lead to corneal scarring with a permanent reduction in visual acuity.

Keywords: Corneal cross-linking; infectious crystalline keratopathy; keratitis; streptococcus.

Figure 1

(a and b) Slit-lamp examination of the right eye showed diffuse conjunctival injection and multiple white, needle-like, branching stromal infiltrates

Figure 2

Eight weeks after topical antibiotic treatment, stromal infiltration has resolved and resulted in an avascularized stromal scar