Management of corneal melting after collagen cross-linking for keratoconus: a case report and a review of the literature

• Published in: BMC ophthalmology 2024-03, Vol.24 (1), p.131-131, Article 131
• Main Authors: Moramarco, Antonio, di Geronimo, Natalie, Gardini, Lorenzo, Grendele, Arianna, Fontana, Luigi
• Format: Article
• Language: English
• Subjects: Acuity; Care and treatment; Case Report; Case reports; Chemical bonds; Child; Collagen; Collogen cross-linking; Conjunctiva; Contact lenses; Cornea; Corneal melting; Corneal transplantation; Corneal Transplantation - methods; Corneal Ulcer - surgery; Cross-linking; Debridement; Dermatitis; Development and progression; Diabetes; Epithelium; Etiology; Eye surgery; Humans; Inflammation; Keratitis; Keratoconus; Keratoconus - drug therapy; Keratoconus - surgery; Keratoplasty, Penetrating - methods; Lamellar keratoplasty; Literature reviews; Male; Melting; Nonsteroidal anti-inflammatory drugs; Patients; Pediatrics; Retrospective Studies; Streptococcus infections; Surgery; Treatment Outcome; Visual acuity; Vitamin B
• ISSN: 1471-2415; 1471-2415
• DOI: 10.1186/s12886-024-03400-1

We describe the management of a case of severe corneal melting after corneal cross-linking (CXL) treated with a staged approach using a conjunctival flap followed by deep anterior lamellar keratoplasty (DALK). A 12-year-old male developed severe corneal melting with pending perforation after an accelerated epithelium-off CXL protocol. We initially treated the patient with a conjunctival flap to prevent perforation. Three months later, we performed DALK to restore vision. Conjunctival flap surgery allowed us to avoid corneal perforation and penetrating keratoplasty (PK) à chaud. Once the inflammation had resolved, we recessed the conjunctiva and performed DALK for optical purposes. Twelve months later, the graft was clear and the corrected visual acuity was 20/25 (Snellen). No complications occurred after surgery. Although CXL is considered a safe procedure, in rare cases it can lead to serious complications, such as corneal haze, infectious and non-infectious keratitis, stromal melting and perforation. Corneal melting and perforation are usually managed by emergency PK. Herein we suggest a staged approach involving an emergency conjunctival flap followed by DALK at a later time that allowed us to avoid PK à chaud.