Peripheral sterile corneal infiltrate after cross linking in keratoconus: A case report

Abstract

Aims/Purpose: The aim of our work is to describe the clinical aspect of sterile corneal infiltrates after cross linking and to evaluate the risk factors involved in their occurrence.Methods: We report the case of a young girl, followed for bilateral keratoconus having made a cross linking which was complicated by sterile catarrhal infiltrates.Results: This is a 15 years old girl, followed for allergic conjunctivitis with notion of self‐medication. The ophthalmological examination on admission found a visual acuity with correction counting fingers at 1 metre in oculus uterque (OU), some conjunctival papillae, minimal blepharitis, clear cornea, cortico‐nuclear cataract ocular tone was 10 mmHg in OU, normal fundus in OU. A corneal topography was performed showing signs of bilateral keratoconus classified as stage III according to the Krumeich classification. An emergency cross linking was indicated in OU starting with the OL, the patient was put on a topical antibiotic treatment, artificial tears with a daily control. At 4 days post‐op, the cornea had completely re‐epithelialized with the presence of a slight central haze and the appearance of 2 inferior stromal opacities of 1 mm/1 mm associated with a crescent infiltrate and 2 similar superior stromal opacities taking the fluorescent in front of the free edge. A corneal swab was taken for bacteriological, mycological and parasitological study and came back negative. The patient was initially put on ceftazidime and vancomycin based eye drops with a blepharitis treatment based on azyter collyrium lavage and artificial tear. The examination 48 h later showed persistence of stromal opacities without taking fluo. A local corticosteroid therapy was started with strict monitoring. The evolution was marked by an almost total regression of the stromal opacities and a disappearance of the central haze. The diagnosis of sterile infiltrate was made in view of the marked clinical improvement under local corticosteroid therapy and the absence of germs in the corneal sample.Conclusions: Evaluation of risk factors showed that epithelial injury may be the common pathway in pathogenesis, as no sterile infiltrate in Epi‐on CXL occurred, and postoperative NSAIDs use increased the risk of developing sterile infiltrates approximately fourfold.