Polymicrobial keratitis after a collagen cross-linking procedure with postoperative use of a contact lens: a case report.
OBJECTIVE
: To report a case of polymicrobial keratitis caused by Streptococcus salivarius, Streptococcus oralis, and coagulase-negative Staphylococcus sp. in a patient who underwent collagen cross-linking for keratoconus.


METHODS
: Case report.


RESULTS
: A 32-year-old male presented with a 1-day history of a painful red eye, occurring 3 days after he had undergone a collagen cross-linking with riboflavin and UV-A on his left eye for keratoconus. He admitted to removing his bandage contact lens and cleaning it in his mouth before reapplying it in his eye. On presentation, a severe keratitis with an 8-mm epithelial defect and 360-degree ring infiltrate was found. Culture results from his contact lens were positive for S. salivarius and S. oralis, and coagulase-negative Staphylococcus sp. were grown from his corneal scrapings.


CONCLUSIONS
: Collagen cross-linking is a promising procedure for the treatment of progressive keratoconus with minimal reported side effects. However, the possibility of a secondary infection after the procedure exists because the patient is subjected to epithelial debridement and the application of a soft contact lens. The role of the UV light on the immune mechanisms of the cornea and its effect on corneal wound healing warrant further investigation.
Corneal Unit, Sydney Eye Hospital, New South Wales, Australia.
Katherine V
KV
Zamora
John J
JJ
Males
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003094:Collagen / Q000378:metabolism; D003261:Contact Lenses / Q000009:adverse effects*; D003320:Corneal Ulcer / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D004359:Drug Therapy, Combination; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D007640:Keratoconus / Q000188:drug therapy / Q000378:metabolism; D008297:Male; D010778:Photochemotherapy / Q000009:adverse effects*; D017319:Photosensitizing Agents / Q000627:therapeutic use; D012256:Riboflavin / Q000627:therapeutic use; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D013210:Staphylococcus / Q000302:isolation & purification; D013290:Streptococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D019533:Streptococcus oralis / Q000302:isolation & purification; D014466:Ultraviolet Rays; D014792:Visual Acuity
D000900:Anti-Bacterial Agents; D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin