title: Diclofenac-induced acute corneal melt after collagen crosslinking for keratoconus.
abstract: OBJECTIVE
  We report a case of acute corneal melt with perforation in a patient with keratoconus after collagen crosslinking treatment and the use of topical diclofenac and proparacaine eyedrops.
  
  
  METHODS
  The authors present a case report with clinicopathologic correlation.
  
  
  RESULTS
  A patient diagnosed with keratoconus underwent corneal collagen crosslinking followed by postoperative use of ofloxacin, dexamethasone, diclofenac, and proparacaine eyedrops. He presented 1 week later with corneal melt and perforation and was treated initially with tissue glue and bandage contact lens application followed by a penetrating keratoplasty on Day 12. The graft was clear at 1 month. A histologic examination revealed corneal perforation with surrounding stromal loss and inflammatory infiltrates.
  
  
  CONCLUSIONS
  Use of diclofenac sodium and proparacaine eyedrops after surgery was possibly responsible for the corneal melt in our patient. Patients who have undergone crosslinking treatment should be observed closely until the corneal epithelium heals completely.
authors.affiliation: Gokhale Eye Hospital and Eyebank, Mumbai, India. nikgokhale@yahoo.com
authors.forename: Nikhil S
authors.initials: NS
authors.lastname: Gokhale
authors.forename: Geeta K
authors.initials: GK
authors.lastname: Vemuganti
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D003094:Collagen / Q000378:metabolism*; D003316:Corneal Diseases / Q000139:chemically induced* / Q000601:surgery; D057112:Corneal Perforation / Q000139:chemically induced / Q000601:surgery; D003319:Corneal Stroma / Q000378:metabolism; D004008:Diclofenac / Q000009:adverse effects*; D006801:Humans; D007640:Keratoconus / Q000188:drug therapy* / Q000378:metabolism; D015948:Keratoplasty, Penetrating; D008297:Male; D010778:Photochemotherapy; D017319:Photosensitizing Agents; D014014:Tissue Adhesives / Q000008:administration & dosage; D014466:Ultraviolet Rays; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D017319:Photosensitizing Agents; D014014:Tissue Adhesives; D004008:Diclofenac; D003094:Collagen