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.
Zamora
Katherine V
KV
Corneal Unit, Sydney Eye Hospital, New South Wales, Australia.
Males
John J
JJ
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