Acute Idiopathic Endotheliitis Early After Corneal Cross-linking With Riboflavin and Ultraviolet-A.

Abstract:

PURPOSE:To present a case of acute idiopathic endotheliitis occurred early after corneal collagen cross-linking (CXL) for progressive keratoconus, and to discuss possible risk factors, causes, and other similar complications in the literature. METHODS:A 24-year-old woman with bilateral keratoconus underwent a corneal de-epithelization and subsequently CXL in the right eye, which was performed with the application of 0.1% riboflavin with 20% dextran, and exposure to ultraviolet-A light (370 nm, 2.9-3.1 mW/cm) for 30 minutes. A bandage contact lens was placed until complete re-epithelialization. Postoperatively, the patient received 0.5% topical moxifloxacin (3 times a day) and preservative free artificial tears (6 times a day). RESULTS:Postoperatively, the patient presented with significant hyperemia and photophobia on day 3. On biomicroscopy, ring-shaped endothelial infiltrates and localized corneal edema were observed in the inferior paracentral location of the cornea. Idiopathic endotheliitis was diagnosed, the therapeutic contact lens was removed, and 1% prednisolone acetate suspension was started every hour in addition to hypertonic ophthalmic solution every 3 hours. After this intensive corticosteroid treatment, the infiltrates improved and completely resolved after 1 week. CONCLUSIONS:We reported a successfully treated acute idiopathic endotheliitis occurring early after routine CXL. This very rare complication is hypothesized to occur as a result of the phototoxic effect of ultraviolet-A transmission on the corneal endothelium, or as an inflammatory response to surgical trauma or solutions used throughout the procedure.

journal_name

Cornea

journal_title

Cornea

authors

Gumus K

doi

10.1097/ICO.0000000000000110

subject

Has Abstract

pub_date

2014-06-01 00:00:00

pages

630-3

issue

6

eissn

0277-3740

issn

1536-4798

journal_volume

33

pub_type

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