Fungal Infection Post Corneal Cross Linking, Case Record

Ahmed Sedky, FRCOphth,Cairo, Egypt

The author of this poster have received consultant reimbursement from WaveLight Laser Technologies.

The author has no financial interest in the subject matter of this poster.

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Pre-Cross linking24 years old female , BCVA 20/50 Topography = Keratoconus grade 2 Pachymetery Map , 510 Microns

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4 days post X-Linking

White Elevated mass with corneal ulcerationA.Sedky,FRCOphth,Cairo,Egypt

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What happened????

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Fungal or microbial infection?

• Deep Corneal vessles 360 degrees A.Sedky,FRCOphth,Cairo,Egypt

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Or excessive Riboflavin????

• Patient in severe pain, UCVA is HMA.Sedky,FRCOphth,Cairo,Egypt

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Two weeks post X-Linking, Scraping was done

• Lab test = Negative

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One week after scraping

• Re-formation of the same elevated white massA.Sedky,FRCOphth,Cairo,Egypt

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Corneal cross section

• Pentacam Shows thickened elevated massA.Sedky,FRCOphth,Cairo,Egypt

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Patient Follow UpOne Month post X-linking Two months post X-linking

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Patient Follow Up 3 months , healing is better, corneal vessels are less

4 months, healed, white opacity, Corneal vessels regressed , PKP is done

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Conclusion• Do we need some sort of a Nomogram for

CCL?• Do we have to use the same amount of

Riboflavin for all corneal diameter?• Do we have to use the same amount of

Riboflavin for all corneal thickness?