Corneal Melting after Collagen Cross-Linking for Keratoconus in a Thin Cornea of a Diabetic Patient Treated with Topical Nepafenac: A Case Report with a Literature Review.
OBJECTIVE
To report the case of a 50-year-old woman with diabetes that presented with corneal melting and perforation 6 weeks after collagen cross-linking (CxL) for keratoconus (KC) and postoperative use of nepafenac eye drops, a nonsteroidal anti-inflammatory drug (NSAID).


METHODS
This is a case report of a patient with diabetes, KC and a thin cornea that had undergone left eye corneal CxL at a different hospital followed by postoperative use of nepafenac eye drops for 6 weeks.


RESULTS
The patient presented for the first time to our clinic with left corneal melting, perforation and iris prolapse 6 weeks after corneal CxL and topical nepafenac use. She was treated with a left eye tectonic penetrating keratoplasty, extracapsular cataract extraction, intraocular lens implantation and pupilloplasty.


CONCLUSIONS
The corneal melting and perforation in this patient was associated with multiple risk factors: (1) nepafenac eye drop use, (2) CxL in a cornea thinner than 400 µm and (3) diabetes. The recommended corneal thickness limits should be respected. Topical NSAIDs should be used with caution if used as postoperative treatment after corneal CxL and in patients with diabetes, epithelial defect or delayed healing, because of the possible increased risk for corneal melting when multiple risk factors are observed.
Department of Ophthalmology, Faculty of Medicine, University Hospital 'Dr. Jose Eleuterio Gonzalez', Autonomous University of Nuevo Leon (UANL), Monterrey, Mexico.
Karim
K
Mohamed-Noriega
Department of Ophthalmology, Faculty of Medicine, University Hospital 'Dr. Jose Eleuterio Gonzalez', Autonomous University of Nuevo Leon (UANL), Monterrey, Mexico.
Karla
K
Butrón-Valdez
Department of Ophthalmology, Faculty of Medicine, University Hospital 'Dr. Jose Eleuterio Gonzalez', Autonomous University of Nuevo Leon (UANL), Monterrey, Mexico.
Jeronimo
J
Vazquez-Galvan
Department of Ophthalmology, Faculty of Medicine, University Hospital 'Dr. Jose Eleuterio Gonzalez', Autonomous University of Nuevo Leon (UANL), Monterrey, Mexico.
Jibran
J
Mohamed-Noriega
Department of Ophthalmology, Faculty of Medicine, University Hospital 'Dr. Jose Eleuterio Gonzalez', Autonomous University of Nuevo Leon (UANL), Monterrey, Mexico.
Humberto
H
Cavazos-Adame
Department of Ophthalmology, Faculty of Medicine, University Hospital 'Dr. Jose Eleuterio Gonzalez', Autonomous University of Nuevo Leon (UANL), Monterrey, Mexico.
Jesús
J
Mohamed-Hamsho
Corneal collagen cross-linking; Corneal melting; Diabetes; Eye drops; Nepafenac; Nonsteroidal anti-inflammatory drugs