Corneal necrosis following an epithelium-off accelerated cross-linking for keratoconus, a case report and literature review

Abstract

A case report of extensive corneal melt following epithelium-off accelerated corneal cross-linking (CXL) as a treatment of keratoconus, along with a review of the literature on noninfectious corneal melting after CXL, is presented. A 22-year-old male patient with a medical record of advanced bilateral keratoconus acquired acute corneal necrosis following an epithelium-off accelerated CXL procedure. The patient underwent therapeutic keratoplasty. Bacteriological analysis of the excised cornea following surgery revealed no organisms in direct examination or culture. Histological findings identified an inflammatory infiltrate limited to the superficial stromal layer associated with fibrinoid necrosis. Additionally, case reports of noninfective corneal melting following CXL from year 2000 until year 2023 were analyzed in comparison to our case. This case emphasized the importance of re-evaluating safety protocols for accelerated CXL, particularly in patients with thin corneas.