Severe microbial keratitis and associated perforation after corneal crosslinking for keratoconus

Cont Lens Anterior Eye. 2015 Apr;38(2):134-7. doi: 10.1016/j.clae.2014.10.004. Epub 2014 Nov 28.


Purpose: To report two cases of microbial keratitis with subsequent corneal perforation immediately following corneal collagen crosslinking (CXL).

Methods: Retrospective case note review.

Results: First case was a 19 year old female presented with staphylococcal corneal abscess 3 days post CXL procedure. Corneal perforation occurred during hospital admission and was successfully treated with corneal gluing. Microbial keratitis eventually resolved, with both topical and systemic antibiotics therapy, resulting in a vascularized corneal scar. Second case was an 18 year old male whom developed Methicillin Resistant Staphylococcus aureus (MRSA) corneal abscess 5 days after CXL procedure for progressive keratoconus. Corneal perforation occurred 48 h after presentation and patient underwent uneventful corneal gluing. Although infective keratitis was successfully treated with topical therapy, patient had visual outcome of count fingers due to scarring.

Conclusions: CXL has been widely used in the treatment of corneal ectatic conditions and complications, such as infective keratitis, are uncommon post procedure. We present two cases of severe microbial keratitis with subsequent corneal perforation within 7 days of CXL. The exact mechanism for the accelerated keratolysis process is unclear. Nonetheless, patients should be well-informed of such potentially devastating complication.

Keywords: Corneal collagen cross linking; Keratoconus; MRSA; Microbial keratitis; Staphylococcus.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Adult
  • Corneal Perforation / diagnosis
  • Corneal Perforation / etiology*
  • Corneal Perforation / therapy*
  • Eye Infections, Bacterial / diagnosis
  • Eye Infections, Bacterial / etiology
  • Eye Infections, Bacterial / therapy
  • Female
  • Humans
  • Keratitis / diagnosis
  • Keratitis / etiology*
  • Keratitis / therapy*
  • Keratoconus / complications
  • Keratoconus / drug therapy*
  • Male
  • Photosensitizing Agents / therapeutic use
  • Riboflavin / therapeutic use
  • Staphylococcal Infections / diagnosis
  • Staphylococcal Infections / etiology
  • Staphylococcal Infections / therapy
  • Treatment Outcome
  • Ultraviolet Therapy / adverse effects*


  • Photosensitizing Agents
  • Riboflavin