title: Peripheral sterile corneal ring infiltrate after riboflavin-UVA collagen cross-linking in keratoconus.
abstract: OBJECTIVE
  To present 7 cases of peripheral sterile corneal infiltrates that occurred after corneal cross-linking (CXL) for progressive keratectasia.
  
  
  METHODS
  Seven patients who had their progressive keratoconus documented underwent corneal deepithelization and subsequently CXL, which was performed with the application of 0.1% riboflavin with 20% dextran, and exposure to UVA light (370 nm, 2.9-3.1 mW/cm(2)) for 30 minutes.
  
  
  RESULTS
  Nearly a week after the procedure, the patients presented with peripheral stromal infiltrates. The ring-like infiltrates were superficial and were present at the 9.0-mm zone. Sterile infiltration was diagnosed. Patients were treated with topical corticosteroids, and complete resolution was achieved after a few weeks of treatment.
  
  
  CONCLUSIONS
  We hypothesize that the phototoxic effect on the corneal stroma may be the main mechanism that triggers these infiltrates. Alternatively, alterations in antigenicity that occur in native proteins after CXL could result in patients recognizing the proteins as nonself and mounting immune responses.
authors.affiliation: Sadalla Amin Ghanem Eye Hospital, Joinville, Santa Catarina, Brazil. ramonghanem@gmail.com
authors.forename: Ramon C
authors.initials: RC
authors.lastname: Ghanem
authors.forename: Marcelo V
authors.initials: MV
authors.lastname: Netto
authors.forename: Vinícius C
authors.initials: VC
authors.lastname: Ghanem
authors.forename: Marcony R
authors.initials: MR
authors.lastname: Santhiago
authors.forename: Steven E
authors.initials: SE
authors.lastname: Wilson
mesh_terms: D000293:Adolescent; D000328:Adult; D003094:Collagen / Q000378:metabolism*; D003316:Corneal Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D003319:Corneal Stroma / Q000378:metabolism / Q000473:pathology; D003432:Cross-Linking Reagents / Q000009:adverse effects*; D018450:Disease Progression; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007640:Keratoconus / Q000188:drug therapy* / Q000378:metabolism; D008297:Male; D017319:Photosensitizing Agents / Q000009:adverse effects* / Q000627:therapeutic use; D012256:Riboflavin / Q000009:adverse effects* / Q000627:therapeutic use; D014466:Ultraviolet Rays; D055815:Young Adult
chemical_list: D003432:Cross-Linking Reagents; D005938:Glucocorticoids; D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin