Herpetic keratitis with iritis after corneal crosslinking with riboflavin and ultraviolet A for keratoconus

Abstract

A 21-year-old woman had crosslinking for keratoconus in the right eye; the left eye was scheduled for penetrating keratoplasty. Five days postoperatively, she presented with geographic epithelial keratitis and iritis. Analysis of tear samples by polymerase chain reaction confirmed the diagnosis. The patient was treated with oral steroids and acyclovir, with significant improvement. Two months postoperatively, the visual acuity was improved and there was no evidence of herpetic disease recurrence. Crosslinking can induce herpetic keratitis with iritis even in patients with no history of herpetic disease. Early diagnosis and proper treatment are essential for a favorable outcome.

Effect of corneal epithelium on ultraviolet-A and riboflavin absorption

“…The CXL protocol recommended by Wollensak et al (3) states that the central epithelium should be debrided before treatment to allow penetration of riboflavin into the corneal stroma (epi-off technique). However, removal of the epithelium can increase the risks of corneal infections, ulcers, haze, scarring and infiltrates, beyond longer recovery time, discomfort and postoperative pain experienced by patients (9)(10)(11)(12) . Recently, slight modifications of this technique were proposed to overcome the potential disadvantages of epithelium removal: one approach advocates the use of multiple applications of topical anesthetic eye drops to loosen the tight junctions of the corneal epithelial cells, thus facilitating riboflavin penetration through an intact epithelium (13,14) .…”

Microsporidial Keratitis after Collagen Cross-linking

“…It has been associated with the occurrence of infectious keratitis in the postoperative period. [1][2][3][4][5][6][7][8] We present a case of microsporidial keratitis after collagen cross-linking.…”

Corneal Collagen Cross-linking for Treatment of Bacterial and Herpetic Keratitis

“…Several cases of bacterial keratitis such as Pseudomonas keratitis [26], Escherichia coli keratitis [27] and polymicrobial keratitis [28] have also been reported after UV-A/ riboflavin corneal cross-linking. Herpetic keratitis with iritis after corneal cross-linking has also been reported [29]. Although, keratitis following CXL have been attributed to several factors such as the postoperative use of a soft bandage contact lens and topical corticosteroids and the presence of an epithelial defect, as trials of corneal CXL in treatment of corneal disorders are increasing, it seems necessary to conduct studies to evaluate the possible adverse effects of the UV light on the immune mechanisms of the cornea and the corneal wound healing processes.…”