Keratopathy After Cross-linking for Keratoconus

Purpose: To report 2 cases of keratopathy after uneventful cross-linking procedures for grade 3 keratoconus. Methods: Two patients (21 and 11 years old) with grade 3 keratoconus underwent uneventful cross-linking in 1 eye. In both patients, multiple peripheral stromal precipitates, which extended centripetally, were observed 48 hours after the procedure. Sample cultures were negative for bacteria, fungi, and parasites. Results: Cornea infiltrates slowly resolved after combined topical antibiotic/ antifungal/povidone/steroids treatment. Final best spectacle-corrected visual acuity was 20/25 for patient 1, after uneventful bilateral toric intraocular contact lens (ICL) (Staar Surgical) implantation, but faint and paracentral scarring persisted. Final best-corrected visual acuity was 20/25 for patient 2 with gaspermeable contact lens wear, despite stromal scarring. Conclusions: Cross-linking associated with sterile keratitis is an unusual entity of unknown etiology, which can lead to stromal scarring.