title: Endothelial failure after collagen cross-linking with riboflavin and UV-A: case report with literature review.
abstract: OBJECTIVE
  To report a case of endothelial decompensation after a collagen cross-linking (CXL) procedure for keratoconus.
  
  
  METHODS
  An 18-year-old boy had CXL for keratoconus in the right eye. He developed keratouveitis with generalized corneal edema seen 3 weeks after the procedure. Polymerase chain reaction for aqueous humor Herpes simplex virus was negative. The patient was treated with topical steroids. Specular microscopy revealed mildly reduced density of endothelial cells. On follow-up to 6 months, corneal edema increased with the formation of epithelial bullae. Penetrating keratoplasty was performed. Possible causes for this complication are discussed.
  
  
  RESULTS
  Clinical and histopathological analyses revealed generalized loss of endothelial cells along with signs of inflammation.
  
  
  CONCLUSIONS
  Although it is considered very safe, collagen CXL can cause severe keratouveitis and endothelial failure.
authors.affiliation: Cornea and Anterior Segment Department, L.V. Prasad Eye Institute, Hyderabad, India. bhupesh@lvpei.org
authors.forename: Bhupesh
authors.initials: B
authors.lastname: Bagga
authors.forename: Shivani
authors.initials: S
authors.lastname: Pahuja
authors.forename: Somasheila
authors.initials: S
authors.lastname: Murthy
authors.forename: Virendra S
authors.initials: VS
authors.lastname: Sangwan
mesh_terms: D000293:Adolescent; D003094:Collagen / Q000378:metabolism*; D015715:Corneal Edema / Q000209:etiology* / Q000601:surgery; D055954:Corneal Endothelial Cell Loss / Q000209:etiology* / Q000601:surgery; D063171:Corneal Pachymetry; D003319:Corneal Stroma / Q000378:metabolism; D019781:Corneal Topography; D003432:Cross-Linking Reagents / Q000627:therapeutic use*; D006801:Humans; D007634:Keratitis / Q000209:etiology / Q000601:surgery; D007640:Keratoconus / Q000188:drug therapy* / Q000378:metabolism; D015948:Keratoplasty, Penetrating; D008297:Male; D017319:Photosensitizing Agents / Q000627:therapeutic use; D011183:Postoperative Complications; D012256:Riboflavin / Q000627:therapeutic use*; D014466:Ultraviolet Rays
chemical_list: D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin