|
 |
 |
|
A Therapeutic Challenge Microbial Keratitis following Collagen Cross Linkage in a case of advance Keratoconus A case report 1 .Jaya Kaushik¹ Affiliation: Purpose: To analyses an unusual occurrence and subsequent strategies of management and visual rehabilitation of uniocular infectious keratitis following bilateral C3R with UVA treatment in a case of progressive keratoconus. Methods: Pre C3R status revealed best corrected visual acuity of 6/12 with - 4 Dsph and -3.00 D Cyl @ 75 degree in Right eye and -3.50 Sph and -5.00 DCyl @115 degree in left eye. Slit lamp confirmed Keratoconus. Thinnest cornea was 400 & 416 micron .Orbscan proved progressive Keratoconus in both eyes. Bilateral corneal collagen cross linking with riboflavin was performed under strict aseptic conditions in the OT. Results: The first day mild swelling in both upper eye lids with conjunctival congestion was visible. Yet cornea was clear with debrided epithelium and BCL in situ. Marked circumciliary congestion and subepithelial haze with superficial 2 to 3 stromal infiltrates and stromal oedema on next day confirmed infective keratitis. Superficial corneal scraping was done, BCL and riboflavin drops sent for microbial before starting antimicrobial. The infiltrates and stromal oedema resolved and subepithelial haze gradually decreased. Microbial keratitis did not influence the course of CXL treatment. Significant improvement in astigmatism, BCVA and maximum simulated keratometry values was observed at 6 months interval. However residual nebular grade opacity remained there. Conclusion: Though the CXL procedure is simple and safe, the unusual infections may lead to compromised visual acuity. The use of BCL may increase the risk of infection. Hence a meticulous approach should be followed. |
 |