Sterile keratitis after uneventful corneal collagen cross-linking in a patient with Axenfeld-Rieger syndrome
To report on a keratoconus (KC) patient with Axenfeld-Rieger syndrome (ARS) who developed sterile keratitis after accelerated corneal collagen cross-linking (CXL).
An 18-year-old patient with ARS and KC who had previously undergone intrastromal ring segment implantation underwent accelerated CXL (9 mW/cm2 UVA intensity for 10 min).
After uneventful surgery, the patient presented with severe photophobia, redness of the eye, and decreased vision 72 h following the procedure. Slit-lamp examination showed anterior multiple superficial stromal infiltrates in the central cornea with an overlying epithelium defect. Due to the lack of pain and absence of any pathogen from corneal samples, a diagnosis of sterile keratitis was considered. A combination of topical antibiotic and corticosteroid regimen was administered. Three months after CXL slit-lamp examination showed a mild stromal scar overlying the central cornea, which did not decrease visual acuity.
The mechanism by which the sterile keratitis occurs following CXL remains unclear. For our case, the reason of post-CXL sterile keratitis could be considered as an immune response due to the staphylococcal antigens. Furthermore, the possible developmental disturbance of corneal stroma in ARS might have contributed to the development of post-CXL sterile keratitis.
KeywordsAxenfeld-Rieger syndrome Corneal collagen cross-linking Keratoconus Sterile keratitis
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in this study involving human participant were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Human and animals rights
This article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from the participant included in this study. Additional informed consent was obtained from the participant for whom identifying information is included in this article. The participant gave written informed consent for publication which was added to the supplementary material section.
The patient has consented to the submission of the case report for submission to the journal.
- 4.Kamińska A, Sokołowska-Oracz A, Pawluczyk-Dyjecińska M et al (2007) Variability of clinical manifestations in the family with Axenfeld-Rieger syndrome. Klin Ocz 109:321–326Google Scholar