Endothelial failure after collagen cross-linking with riboflavin and UV-A: case report with literature review.

Bhupesh Bagga, Shivani Pahuja, Somasheila Murthy, Virendra S Sangwan

Journal: Cornea 2012;31(10):1197-200

PMID: 22960648

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Abstract

PURPOSE

To report a case of endothelial decompensation after a collagen cross-linking (CXL) procedure for keratoconus.

METHODS

An 18-year-old boy had CXL for keratoconus in the right eye. He developed keratouveitis with generalized corneal edema seen 3 weeks after the procedure. Polymerase chain reaction for aqueous humor Herpes simplex virus was negative. The patient was treated with topical steroids. Specular microscopy revealed mildly reduced density of endothelial cells. On follow-up to 6 months, corneal edema increased with the formation of epithelial bullae. Penetrating keratoplasty was performed. Possible causes for this complication are discussed.

RESULTS

Clinical and histopathological analyses revealed generalized loss of endothelial cells along with signs of inflammation.

CONCLUSIONS

Although it is considered very safe, collagen CXL can cause severe keratouveitis and endothelial failure.

Address: Cornea and Anterior Segment Department, L.V. Prasad Eye Institute, Hyderabad, India. [email protected]

DOI: 10.1097/ICO.0b013e31823cbeb1

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MeSH Terms: Adolescent, Collagen, Corneal Edema, Corneal Endothelial Cell Loss, Corneal Pachymetry, Corneal Stroma, Corneal Topography, Cross-Linking Reagents, Humans, Keratitis, Keratoconus, Keratoplasty, Penetrating, Male, Photosensitizing Agents, Postoperative Complications, Riboflavin, Ultraviolet Rays