title: Deep stromal opacity after corneal cross-linking.
abstract: OBJECTIVE
  To describe 3 cases with deep corneal stromal opacity that occurred several months after corneal cross-linking.
  
  
  METHODS
  A 36-year-old man, a 19-year-old man, and a 14-year-old girl underwent corneal cross-linking for their progressive keratoconus. Corneal cross-linking was performed according to the Dresden protocol. The corneal epithelium was ablated using an excimer laser in 2 cases and manually in 1 case. After 30 minutes of riboflavin presoaking, hypotonic riboflavin solution was applied until the corneal stroma swelled, after which the eyes were exposed to ultraviolet irradiation. Slit-lamp microscopy findings, uncorrected visual acuity, best-corrected visual acuity, manifest refraction, intraocular pressure, and corneal endothelial cell counts were evaluated, and corneal topography with Scheimpflug imaging was performed.
  
  
  RESULTS
  In all cases, the epithelium healed without delay. All eyes showed mild stromal infiltration a few days after the procedure; however, the inflammation was resolved within 1 week. The corneal stroma revealed no opacity up to 1 month after the procedure. A deep stromal opacity that extended to the inferior paracentral area developed after a few months and remained for 6 months to 1 year. Because the opacity was not on the visual axis, the visual acuity was not involved.
  
  
  CONCLUSIONS
  Deep stromal opacity developed several months after uneventful corneal cross-linking. Postoperative inflammation may play a crucial role in its pathogenesis.
authors: Department of Ophthalmology, National Defense Medical College, Saitama, Japan. nkato@ndmc.ac.jp
authors: Naoko
authors: N
authors: Kato
authors: Kenji
authors: K
authors: Konomi
authors: Megumi
authors: M
authors: Saiki
authors: Kazuno
authors: K
authors: Negishi
authors: Masaru
authors: M
authors: Takeuchi
authors: Jun
authors: J
authors: Shimazaki
authors: Kazuo
authors: K
authors: Tsubota
mesh_terms: D000293:Adolescent; D000328:Adult; D002452:Cell Count; D003094:Collagen / Q000378:metabolism; D003131:Combined Modality Therapy; D003318:Corneal Opacity / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D003319:Corneal Stroma / Q000378:metabolism / Q000473:pathology*; D019781:Corneal Topography; D003432:Cross-Linking Reagents / Q000627:therapeutic use*; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D007640:Keratoconus / Q000188:drug therapy*; D008297:Male; D017319:Photosensitizing Agents / Q000627:therapeutic use; D011183:Postoperative Complications; D012029:Refraction, Ocular / Q000502:physiology; D012256:Riboflavin / Q000627:therapeutic use; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
chemical_list: D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin