title: Keratitis and corneal scarring after UVA/riboflavin cross-linking for keratoconus.
abstract: OBJECTIVE
  To report four cases of severe keratitis after standard corneal collagen cross-linking (CXL) treatment for keratoconus.
  
  
  METHODS
  Four patients with progressive keratoconus from two different centers were treated by ultraviolet A (UVA) CXL, using riboflavin as a photosensitizer. The epithelium was removed over the central 8 to 9 mm of the cornea. Riboflavin 0.1% in dextran 20% was instilled every 2 minutes for 30 minutes before UVA exposure. The UV-X light source (IROC), calibrated at 3 mW/cm(2), was applied for 30 minutes while instillation was continued every 2 minutes. At the end of the treatment, a bandage contact lens was applied and topical treatment consisting of a combination of antibiotics and/or anti-inflammatory drops was initiated.
  
  
  RESULTS
  Patients experienced delayed (after more than 24 hours) symptoms and signs of inflammation. The eyes showed pronounced ciliary redness with cells in the anterior chamber and central keratic precipitates; multiple white infiltrates had developed at the edge and within the area of CXL. High-dose topical or subconjunctival corticosteroids led to rapid initial improvement of symptoms and signs. Herpes virus could not be detected on the ocular surface or on the anterior chamber tap of one patient.
  
  
  CONCLUSIONS
  We report four cases of keratitis and corneal scarring from a total of 117 eyes treated with CXL. The location of the scarring determined the amount of loss of visual acuity: in two eyes, there was a persistent decrease in best spectacle-corrected visual acuity.
authors.affiliation: Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium. carina.koppen@uza.be
authors.forename: Carina
authors.initials: C
authors.lastname: Koppen
authors.forename: Jérôme C
authors.initials: JC
authors.lastname: Vryghem
authors.forename: Laure
authors.initials: L
authors.lastname: Gobin
authors.forename: Marie-José
authors.initials: MJ
authors.lastname: Tassignon
mesh_terms: D000293:Adolescent; D000328:Adult; D002921:Cicatrix / Q000175:diagnosis / Q000209:etiology*; D003094:Collagen / Q000378:metabolism; D003315:Cornea / Q000473:pathology*; D003319:Corneal Stroma / Q000378:metabolism; D005260:Female; D006801:Humans; D007634:Keratitis / Q000175:diagnosis / Q000209:etiology*; D007640:Keratoconus / Q000188:drug therapy* / Q000378:metabolism; D008297:Male; D010778:Photochemotherapy / Q000009:adverse effects*; D017319:Photosensitizing Agents / Q000627:therapeutic use; D011183:Postoperative Complications; D012256:Riboflavin / Q000627:therapeutic use*; D014466:Ultraviolet Rays; D014792:Visual Acuity; D055815:Young Adult
chemical_list: D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin