title: Corneal collagen cross-linking in a late-onset graft infectious ulcer: a case report.
abstract: BACKGROUND
  Infectious keratitis following penetrating keratoplasty is a common postoperative complication. Intensive topical and systemic treatments do not always prevent the risk of graft failure. In this report we demonstrate the beneficial anti-microbial effect of corneal collagen cross-linking in a late-onset, sight-threatening, corneal graft ulcer.
  
  
  METHODS
  A 57-year old Caucasian man underwent penetrating keratoplasty in his left eye, due to corneal bullosa after cataract extraction surgery. Twelve months after the penetrating keratoplasty, he visited our emergency service complaining of burning and foreign body sensation in his operated eye. Slit-lamp examination revealed a central, round-shaped ulcer of the graft. Due to poor response to the intensive topical antibiotic therapy, corneal collagen cross-linking was applied 3 days after admission, in an attempt to control the infection. Cultures indicated the predominance of methicillin-resistant Staphylococcus aureus infection. Five days after corneal collagen cross-linking treatment, the epithelium was completely re-epithelized, while the transparency of the transplanted cornea was gradually restored within the 12-month follow-up period. No relapses occurred.
  
  
  CONCLUSIONS
  Corneal collagen cross-linking seems to be a safe and effective therapeutic alternative in resistant cases of infectious keratitis following penetrating keratoplasty.
authors.affiliation: Department of Ophthalmology, University Hospital of Alexandroupolis, 68100 Dragana, Alexandroupolis, Greece. labiris@usa.net.
authors.forename: Georgios
authors.initials: G
authors.lastname: Labiris
authors.forename: Athanassios
authors.initials: A
authors.lastname: Giarmoukakis
authors.forename: Roman
authors.initials: R
authors.lastname: Larin
authors.forename: Haris
authors.initials: H
authors.lastname: Sideroudi
authors.forename: Vassilios P
authors.initials: VP
authors.lastname: Kozobolis
mesh_terms: D016039:Corneal Transplantation; D003320:Corneal Ulcer / Q000628:therapy*; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy*; D013203:Staphylococcal Infections / Q000382:microbiology / Q000628:therapy*