Microsporidial Keratitis after Collagen Cross-linking

Infectious Keratitis Following Corneal Crosslinking: A Systematic Review of Reported Cases: Management, Visual Outcome, and Treatment Proposed

“…[21][22][23]26,29,30 Fluoroquinolones were associated with steroids in one case 22 and with topical nonsteroidal anti-inflammatory drugs in two cases, 22,29 and in the other three cases without association. 21,26,29 Aminoglycosides were used in the other four cases. 24,25,27,28 In all of these cases, the treatment was associated with steroids.…”

“…As none of the studies was analytical, comparative statistical methods could not be applied. A Vega CBM X linker (CSO, Florence, Italy) was used in one study 21 and, in nine studies, [22][23][24][25][26][27][28][29][30] the models of the instruments were not specified. The standard CXL, Dresda protocol, 1 was followed in all of the studies.…”

“…26 According to the microbiological sample results, the postoperative treatment was modified in six patients. 21,23,[25][26][27][28] In a case of S. epidermidis keratitis, topical beta lactam antibiotic (fortified cefazolin 50 mg/ml), 21 following the directions of the antibiotic-sensitivity test (Kirby-Bauer disk-diffusion method), was changed to topical fluoroquinolones (ofloxacin 0.3%) in addiction to topical aminoglycoside (fortified tobramycin 15 mg/ml). After the detection of positivity for Acanthamoeba, topical hexamidine and polymethylenebiguanide (PHMD) were added to the previous treatment with fluoroquinolones (topical levofloxacin) associated with intramuscular cephalosporin.…”

“…There were 10 articles on this topic. [21][22][23][24][25][26][27][28][29][30] According to the protocol for the Cochrane systematic meta-analysis, 31 all of the articles included in this study were classified as level 3 evidence (non-analytical studies: case reports, case series).…”

Corneal Collagen Cross-linking

“…Resolution with an increase in topical steroid therapy has been reported. 82 Microbial keratitis has been reported with different organisms, including Pseudomonas, 83 microsporidia, 91 Acanthamoeba, 84 and Fusarium. 85 The presence of an epithelial defect, contact lens use, and the instillation of topical steroids may predispose to the development of microbial keratitis.…”