Infectious Keratitis Following Corneal Crosslinking: A Systematic Review of Reported Cases: Management, Visual Outcome, and Treatment Proposed.
OBJECTIVE
To describe the infectious complications and the group of pathogens involved in the infection following corneal crosslinking, the visual outcome, and the treatment proposed.


METHODS
A Medline (National Library of Medicine, Bethesda, MD, USA) search from October 2000 to October 2013 was performed to identify all articles describing infectious keratitis following corneal crosslinking treatment. Nineteen articles were selected. Ten articles reported infectious complications of corneal crosslinking treatment were included. Nine articles were excluded, because seven described sterile keratitis, one article was in German, and one reported general complication without describing the infection complication.


RESULTS
A total number of infections reported included 10 eyes. The infectious keratitis was associated with bacteria in five eyes (50%): gram-positive bacteria in three eyes (30%) (staphylococcus epidermidis, S. aureus and streptococcus salivarius plus S. oralis, respectively) and gram-negative bacteria in two eyes (20%) (E. coli; P. aeruginosa); there was herpes virus in two eyes, fungus in two eyes (Fusarium and Microsporidia) (20%), and Acanthamoeba in one eye (10%).


CONCLUSIONS
Only 10 cases of infectious keratitis following corneal crosslinking are published. The most virulent pathogens were Pseudomonas aeruginosa and Acanthamoeba. Less virulent organisms were Escherichia coli and S. epidermidis. Two cases of herpes keratitis were described, suggesting the possibility of systemic antiviral prophylaxis before corneal crosslinking treatment. The most common risk factor of infections identified was postoperative incorrect patient behavior.
a Vissum Corporación Oftalmológica , Alicante , Spain .|b Division of Ophthalmology , University of Rome Sapienza , Rome , Italy , and.
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Abbouda
b Division of Ophthalmology , University of Rome Sapienza , Rome , Italy , and.
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Abicca
a Vissum Corporación Oftalmológica , Alicante , Spain .|c Division of Ophthalmology , Universidad Miguel Hernández , Alicante , Spain.
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Alió
D000328:Adult; D003094:Collagen / Q000378:metabolism; D003319:Corneal Stroma / Q000378:metabolism; D003432:Cross-Linking Reagents / Q000009:adverse effects*; D015817:Eye Infections / Q000188:drug therapy / Q000382:microbiology / Q000503:physiopathology; D006801:Humans; D007634:Keratitis / Q000188:drug therapy / Q000382:microbiology / Q000503:physiopathology; D017319:Photosensitizing Agents / Q000009:adverse effects*; D011183:Postoperative Complications; D012256:Riboflavin / Q000009:adverse effects; D012307:Risk Factors; D014466:Ultraviolet Rays; D014792:Visual Acuity / Q000502:physiology*; D055815:Young Adult
D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin
Corneal; collagen crosslinking; infectious keratitis; treatment; visual outcome