title: Profile of microbial keratitis after corneal collagen cross-linking.
abstract: OBJECTIVE
  To report the profile of microbial keratitis occurring after corneal collagen cross-linking (CXL) in keratoconus patients.
  
  
  METHODS
  A retrospective analysis of 2350 patients (1715 conventional CXL, 310 transepithelial CXL, and 325 accelerated CXL) over 7 years (from January 2007 to January 2014) of progressive keratoconus, who underwent CXL at a tertiary eye care centre, was performed. Clinical findings, treatment, and course of disease of four eyes that developed postprocedural moxifloxacin resistant Staphylococcus aureus (MXRSA) infectious keratitis are highlighted.
  
  
  RESULTS
  Four eyes that underwent CXL (0.0017%) had corneal infiltrates. All eyes that developed keratitis had conventional CXL. Corneal infiltrates were noted on the third postoperative day. Gram's stain as well as culture reported MXRSA as the causative agent in all cases. Polymerase chain reaction (PCR) in each case was positive for eubacterial genome. All patients were treated with fortified antibiotic eye drops, following which keratitis resolved over a 6-week period with scarring. All these patients were on long-term preoperative oral/topical steroids for chronic disorders (chronic vernal keratoconjunctivitis, bronchial asthma, and chronic eczema).
  
  
  CONCLUSIONS
  The incidence of infectious keratitis after CXL is a rare complication (0.0017%). MXRSA is a potential organism for causing post-CXL keratitis and should be identified early and treated aggressively with fortified antibiotics.
authors.affiliation: Narayana Nethralaya Eye Hospital Bangalore, Narayana Nethralaya 121/C, Chord Road, 1st "R" Block, Rajajinagar, Bangalore, Karnataka 560 010, India.
authors.forename: Rohit
authors.initials: R
authors.lastname: Shetty
authors.affiliation: Narayana Nethralaya Eye Hospital Bangalore, Narayana Nethralaya 121/C, Chord Road, 1st "R" Block, Rajajinagar, Bangalore, Karnataka 560 010, India.
authors.forename: Luci
authors.initials: L
authors.lastname: Kaweri
authors.affiliation: Department of Ophthalmology, University Hospital Maastricht, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
authors.forename: Rudy M M A
authors.initials: RM
authors.lastname: Nuijts
authors.affiliation: Narayana Nethralaya Eye Hospital Bangalore, Narayana Nethralaya 121/C, Chord Road, 1st "R" Block, Rajajinagar, Bangalore, Karnataka 560 010, India.
authors.forename: Harsha
authors.initials: H
authors.lastname: Nagaraja
authors.affiliation: Narayana Nethralaya Eye Hospital Bangalore, Narayana Nethralaya 121/C, Chord Road, 1st "R" Block, Rajajinagar, Bangalore, Karnataka 560 010, India.
authors.forename: Vishal
authors.initials: V
authors.lastname: Arora
authors.affiliation: Narayana Nethralaya Eye Hospital Bangalore, Narayana Nethralaya 121/C, Chord Road, 1st "R" Block, Rajajinagar, Bangalore, Karnataka 560 010, India.
authors.forename: Rajesh S
authors.initials: RS
authors.lastname: Kumar
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015984:Causality; D015897:Comorbidity; D003432:Cross-Linking Reagents / Q000627:therapeutic use; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007634:Keratitis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D007640:Keratoconus / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D008297:Male; D017319:Photosensitizing Agents / Q000627:therapeutic use; D012189:Retrospective Studies; D012256:Riboflavin / Q000627:therapeutic use*; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D016896:Treatment Outcome; D014467:Ultraviolet Therapy / Q000379:methods; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D012256:Riboflavin