Infectious Keratitis After Corneal Cross-Linking: A Retrospective Case Series

Abstract

Purpose: To evaluate the risk of infectious keratitis after corneal cross-linking (CXL) in eyes with corneal ectasia.

Methods: In this retrospective case series, we reviewed the medical records of patients with a diagnosis code for keratitis over a 6-month period after all CXLs performed in the Department of Ophthalmology at Oslo University Hospital from 2007 to 2020. To compare our results with existing literature, we reviewed studies evaluating the risk of keratitis after CXL.

Results: A total of 1809 CXLs were performed in our department during the study period. The annual number of CXLs increased from 3 in 2007 to 219 in 2020. We identified 11 (0.6%) cases registered with a keratitis code within 6 months after CXL, of which the physician considered 5 (0.3%, 95% confidence interval, 0.1%-0.6%) to be procedure-related infectious keratitis. The microbiological agents were Staphylococcus aureus (n = 3), Acanthamoeba (n = 1), or unknown (n = 1). To our knowledge, this is the largest European study to report the risk of infectious keratitis after CXL. The literature review, including papers published up to October 2024, identified 23 relevant studies that reported infectious keratitis in 0% to 2.6% of eyes after CXL treatment.

Conclusions: We found a low incidence of infectious keratitis after CXL. Our rate was comparable to that reported in the literature, indicating a low risk of this complication in eyes with corneal ectasia treated with CXL.

Keywords: CXL; corneal cross-linking; corneal ectasia; keratitis; keratoconus.