Purpose: 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). Methods: 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. Results: 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. Conclusions: 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.

Moramarco, A., di Geronimo, N., Gardini, L., Grendele, A., Fontana, L. (2024). Management of corneal melting after collagen cross-linking for keratoconus: a case report and a review of the literature. BMC OPHTHALMOLOGY, 24(1), 1-5 [10.1186/s12886-024-03400-1].

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

di Geronimo, Natalie;Gardini, Lorenzo;Grendele, Arianna;Fontana, Luigi
2024

Abstract

Purpose: 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). Methods: 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. Results: 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. Conclusions: 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.
2024
Moramarco, A., di Geronimo, N., Gardini, L., Grendele, A., Fontana, L. (2024). Management of corneal melting after collagen cross-linking for keratoconus: a case report and a review of the literature. BMC OPHTHALMOLOGY, 24(1), 1-5 [10.1186/s12886-024-03400-1].
Moramarco, Antonio; di Geronimo, Natalie; Gardini, Lorenzo; Grendele, Arianna; Fontana, Luigi
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/1001567
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