Polymicrobial keratitis after a collagen cross-linking procedure with postoperative use of a contact lens: a case report

Cornea. 2009 May;28(4):474-6. doi: 10.1097/ICO.0b013e31818d381a.

Abstract

Purpose: : To report a case of polymicrobial keratitis caused by Streptococcus salivarius, Streptococcus oralis, and coagulase-negative Staphylococcus sp. in a patient who underwent collagen cross-linking for keratoconus.

Method: : Case report.

Result: : A 32-year-old male presented with a 1-day history of a painful red eye, occurring 3 days after he had undergone a collagen cross-linking with riboflavin and UV-A on his left eye for keratoconus. He admitted to removing his bandage contact lens and cleaning it in his mouth before reapplying it in his eye. On presentation, a severe keratitis with an 8-mm epithelial defect and 360-degree ring infiltrate was found. Culture results from his contact lens were positive for S. salivarius and S. oralis, and coagulase-negative Staphylococcus sp. were grown from his corneal scrapings.

Conclusions: : Collagen cross-linking is a promising procedure for the treatment of progressive keratoconus with minimal reported side effects. However, the possibility of a secondary infection after the procedure exists because the patient is subjected to epithelial debridement and the application of a soft contact lens. The role of the UV light on the immune mechanisms of the cornea and its effect on corneal wound healing warrant further investigation.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anti-Bacterial Agents / therapeutic use
  • Collagen / metabolism
  • Contact Lenses / adverse effects*
  • Corneal Ulcer / diagnosis
  • Corneal Ulcer / drug therapy
  • Corneal Ulcer / microbiology*
  • Drug Therapy, Combination
  • Eye Infections, Bacterial / diagnosis
  • Eye Infections, Bacterial / drug therapy
  • Eye Infections, Bacterial / microbiology*
  • Humans
  • Keratoconus / drug therapy
  • Keratoconus / metabolism
  • Male
  • Photochemotherapy / adverse effects*
  • Photosensitizing Agents / therapeutic use
  • Riboflavin / therapeutic use
  • Risk Factors
  • Staphylococcal Infections / diagnosis
  • Staphylococcal Infections / drug therapy
  • Staphylococcal Infections / microbiology*
  • Staphylococcus / isolation & purification
  • Streptococcal Infections / diagnosis
  • Streptococcal Infections / drug therapy
  • Streptococcal Infections / microbiology*
  • Streptococcus oralis / isolation & purification
  • Ultraviolet Rays
  • Visual Acuity

Substances

  • Anti-Bacterial Agents
  • Photosensitizing Agents
  • Collagen
  • Riboflavin