Sterile Corneal Infiltrate Management After Corneal Crosslinking in Pediatric Keratoconus

Abstract

A 6-year-old female was admitted to the ophthalmology department with a preliminary diagnosis of keratoconus. An accelerated cross-linking (CXL) protocol (9 mW/cm² in 10 minutes) was performed on the right eye. On postoperative day 2, a slit-lamp examination revealed 2 corneal infiltrates with grade 3 haze. Since there was no growth in the cultivated cultures and no response to topical antibiotic treatment, the infiltrates were considered to be sterile, and topical 1% prednisolone drops were applied hourly. Despite topical steroid treatment of 1% prednisolone on postoperative day 5, no significant improvement was observed in the patient's symptoms and slit-lamp findings. Therefore, systemic 1 mg/kg prednisolone (total dose, 15 mg) was added to the treatment on postoperative day 5. One day after initiating the systemic steroid treatment, the infiltrates had shrunk, and the patient's complaints decreased. In patients with keratoconus who are under 10 years of age, the addition of a potent steroid regimen to the treatment may be essential in cases with suspected infiltrates after CXL treatment.

Keywords: Cross-linking; pediatric keratoconus; sterile infiltrate; steroid.

Figure 1

Scheimpflug topography maps of the right and left eyes before the crosslinking treatment.

Figure 2

Slit-lamp photograph of the patient after crosslinking treatment. (a) Postoperative day 2: Two infiltrates with grade 3 haze: one 1.5×1.5 mm in diameter at the 2 o’clock level and the other 0.5x0.5 mm in diameter at the corneal center. (b) Postoperative day 5: Despite topical steroid treatment with 1% prednisolone, no significant improvement was observed in the patient’s symptoms or slit-lamp findings. (c) Postoperative day 8: After systemic prednisolone treatment, the corneal infiltrates were completely resolved and scar formation developed. (d) Postoperative 6 months: Scar formation was present in the cornea center and at the 2 o’clock position.

Figure 3

Scheimpflug axial map comparison before the crosslinking treatment and the results at postoperative 6 months.