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During cross-linking, isotonic riboflavin with dextran causes a significant decrease in corneal thickness, whereas dextran-free isotonic riboflavin causes a significant increase in corneal thickness, thus facilitating the procedure.

Purpose To investigate patient risk factors and to look for potential causes of sterile infiltrates following an unexpected cluster of sterile keratitis after a routine collagen crosslinking (CXL) list. Methods The records of all 148 cases of CXL were reviewed retrospectively. The equipment and solutions used and our clinic's standard operating procedure for CXL were reviewed. An in-vitro experiment to explore the variation in ultraviolet A (UVA) irradiance from fluctuations in the working distance of the UVA lamp was conducted. Results The four patients who developed sterile infiltrates had steeper maximum corneal curvatures (68.0 ± 7.3 D) and thinner pachymetry (389.9 ± 49.0 mm) than the 144 who did not (57.0 ± 8.2 D, P ¼ 0.05; 454.6 ± 45.4 mm, P ¼ 0.08). A corneal curvature of 460 Dand a pachymetry of o425 mm were significant risk factors. All four affected cases obtained a complete resolution with topical antibiotics and steroids. The unaided VA and the maximum K improved from their preoperative levels in three out of four patients. A 2-mm reduction in distance of the VEGA C.B.M. X-Linker from a treated surface increased irradiance to 3.5-3.7 mW/cm 2 , which is above the threshold for endothelial toxicity. Conclusion Patients with thinner and steeper corneas are at an increased risk of developing sterile keratitis. The visual outcomes despite this complication are good.

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All these patients suffered from symptomatic infections and when signs and symptoms were collected (in 6 of them), back pain, myalgia, loss of appetite and asthenia were the most frequent followed by fever, arthralgia and vomiting. Noticeably, none experienced a severe episode nor required to be hospitalized. At this stage, typing using type-specific RT-PCR assays of the two positive samples was performed in one patient and confirmed the secondary infection. DENV1 was isolated in 3 samples from 2019 from 3 patients also diagnosed in 2018. Because of an IgG positive serology, it strongly suggests the heterologous infection despite no typing in 2018. Due to technical issues, 3 samples could not be typed. Four typing results are pending. The median length between the 2 infections was 13 months [min-max: 4.5-18 months].Discussion: These preliminary findings showed that two symptomatic dengue infections can occur even if infections are only distanced of 4 months and suggests that heterologous protection is shorter than expected.Conclusion: These results contrast with the 24 months protection usually reported. Of note and as previously described, it seems that the risk of developing a severe form during secondary infection is increasing with the time interval between the 2 infections.

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