Infectious keratitis after corneal crosslinking: a systematic review

Corneal crosslinking is an FDA approved therapy to stiffen the cornea and prevent progression of corneal ectasia in patients with keratoconus. The standard procedure involves removal of the corneal epithelium (epithelial-off) prior to treatment. Variations to the standard procedure include accelerated crosslinking and transepithelial procedures. This study reviewed what is known regarding the risk for infection following epithelial-off crosslinking, the spectrum of pathogens, and clinical outcomes. Twenty-six publications were identified. All eyes were fit with a bandage contact lens post-operatively. Available data indicate that the overall frequency of infectious keratitis after epithelium-off crosslinking is low. Bacterial infections are the most common, presenting an average of 4.8 days after surgery. The use of steroids and bandage contact lenses in the immediate postoperative period and/or a history of atopic or herpetic disease were associated with infection. These patients require intense post-operative care with prophylactic anti-viral therapy when appropriate.