International Journal of Keratoconus and Ectatic Corneal Diseases

Register      Login

VOLUME 4 , ISSUE 3 ( September-December, 2015 ) > List of Articles


Diffuse Sterile Corneal Infiltration: An Unusual Complication Post Collagen Cross-linkage

Ritu Arora, Sonal Dangda

Citation Information : Arora R, Dangda S. Diffuse Sterile Corneal Infiltration: An Unusual Complication Post Collagen Cross-linkage. Int J Kerat Ect Cor Dis 2015; 4 (3):115-119.

DOI: 10.5005/jp-journals-10025-1111

Published Online: 01-12-2017

Copyright Statement:  Copyright © 2015; The Author(s).



Presenting the course of visually disabling corneal infiltration post uneventful collagen cross-linking (CXL) in a 23 years old male with bilateral keratoconus.


A 23 years old male with bilateral keratoconus underwent cross-linking of left eye with indigenous 0.1% riboflavin dye and 370 nm ultraviolet A irradiation. This patient had an uneventful successful cross-linking performed in right eye 6 months prior with good recovery of vision to LogMAR (6/9 Snellen).


Patient developed diminution of vision, along with redness of eye, photophobia and watering on 3rd day after uneventful cross-linkage. Examination revealed very poor vision; diffuse corneal clouding with multiple superficial stromal infiltrates and incomplete corneal epithelization. A provisional diagnosis of infective keratitis was made, in situ bandage contact lens (BCL) removed and subjected to culture. Intensive fortified topical antibiotics were initiated and steroids withheld. After complete corneal re-epithelization on 6th day, the infiltrations did not decrease in either intensity or number. Response to antibiotics being inadequate, an immune etiology was suspected and full strength topical steroids reinstituted which resulted in slow resolution of infiltration over a 10 weeks period. Last follow-up at 9 months post-CXL, revealed a diffuse stromal haze with unaided visual acuity of LogMAR 0.8 6/36 and best-corrected visual acuity (BCVA) of 0.3 (6/12) with use of a rigid gas permeable lens.


Sterile infiltration post-CXL requiring intense topical steroids is a rare complication of CXL and needs to be differentiated from infective keratitis.

How to cite this article

Bhattacharyya M, Singh K, Mutreja A, Dangda S, Arora R. Diffuse Sterile Corneal Infiltration: An Unusual Complication Post Collagen Cross-linkage. Int J Kerat Ect Cor Dis 2015;4(3):115-119.

PDF Share
  1. Collagen cross-linking with riboflavin and ultraviolet: a light in keratoconus: long-term results. J Cataract Refract Surg 2008 May;34(5):796-801.
  2. Long-term results of riboflavin ultraviolet a corneal collagen cross-linking for keratoconus in Italy: the Siena Eye Cross Study. Am J Ophthalmol 2010 Apr;149(4):585-593.
  3. Management of late corneal haze following photorefractive keratectomy. J Refract Surg 1995 May-Jun;11(3):309-313.
  4. Clin Experi Ophthal 2007;35(6): 580-582.
  5. Corneal collagen cross-linking: a confocal, electron, and light microscopy study of eye bank corneas. Cornea 2009;28(1):62-67.
  6. The swelling pressure of the corneal stroma. Investigat Ophthalmol 1962;1: 158-162.
  7. Collagens and proteoglycans of the corneal extracellular matrix. Brazilian J Med Biologi Res 2003; 36(8):1037-1046.
  8. Hydration behavior of porcine cornea cross-linked with riboflavin and ultraviolet A. J Cataract Refract Surg 2007;33(3):516-521.
  9. Safety of UVA-riboflavin cross-linking of the cornea. Cornea 2007; 26(4):385-389.
  10. Microbial keratitis after corneal collagen cross-linking. J Cataract Refract Surg 2009;35(6):1138-1140.
  11. Acanthamoeba keratitis with perforation after corneal cross-linking and bandage contact lens use. J Cataract Refract Surg 2009;35(4):788-791.
  12. Polymicrobial keratitis after a collagen cross-linking procedure with postoperative use of a contact lens. Cornea 2009;28(4):474-476.
  13. Peripheral sterile corneal ring infiltrate after riboflavin- UVA collagen cross-linking in keratoconus. Cornea 2012; 31(6):702-705.
  14. Corneal infiltrates after corneal collagen cross-linking. J Refract Surg 2010;26(8):609-611.
  15. Sterile keratitis after combined riboflavin-UVA corneal collagen cross-linking for keratoconus. Eye (Lond) 2014;28(11): 1297-1303.
  16. Peripheral sterile corneal infiltrates and melting after collagen cross-linking for keratoconus. J Cataract Refract Surg 2009;35(3):606-607.
  17. Herpetic keratitis with iritis after corneal cross-linking with riboflavin and ultraviolet A for keratoconus. J Cataract Refract Surg 2007; 33(11):1982-1984.
  18. Pseudomonas keratitis after collagen cross-linking for keratoconus: case report and review of literature. J Cataract Refract Surg 2010 Mar;36(3):517-520.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.