DOI: 10.4103/jcos.jcos_22_26 ISSN: 2950-2810

Incidence, Risk Factors, Microbiological Profile, and Treatment Outcomes of Infective Keratitis after Collagen Cross-linking in a Large Cohort of Patients at a Tertiary Care Eye Center

Sunita Chaurasia, Joveeta Joseph, Anubha Rathi, Bhupesh Bagga, Vivek Pravin Dave, Mudit Tyagi, Sanchita Mitra, Subhadra Jalali
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Abstract

Purpose:

The aim of this study was to report the incidence, associated risk factors, microbiological profile, and treatment outcomes of infective keratitis after collagen cross-linking at a tertiary care center.

Materials and Methods:

The retrospective cohort study included patients who had developed infective keratitis after corneal collagen cross-linking (CXL) between 2018 and 2024 (7-year study period).

Results:

A total of 5262 eyes of 4306 patients underwent CXL, of which 13 (0.25%) unilateral eyes developed infective keratitis within a week of the procedure. All were epithelium-off CXL procedures, with eight being hypotonic and five isotonic. The median age was 21 (interquartile range: 16.5–24) years. Eight were males. Microbiological examination revealed gram-positive bacteria in 12/13 eyes, among which Staphylococcus aureus was the most common (11/12 eyes) organism; one was identified as Streptococcus pneumonia , and microbiology was inconclusive in one eye. All isolates were resistant to one or more fluoroquinolones (ciprofloxacin, ofloxacin, levofloxacin, gatifloxacin, and moxifloxacin), while sensitivity to other antibiotics such as vancomycin, cefazolin, linezolid, and chloramphenicol was retained. Out of 11 with S. aureus infection, 4 were methicillin-resistant S. aureus . The ocular comorbid risk factors identified were allergic conjunctivitis in 10 eyes and blepharitis in 1 eye. Management with topical antibiotic therapy with or without glue application resulted in eradication of infection in all eyes. None required therapeutic/tectonic-penetrating keratoplasty.

Conclusions:

Our study showed that ocular surface commensals are the most common organisms implicated in infective keratitis after CXL. S. aureus was the most common isolate. Drug resistance to fluoroquinolones was a noteworthy feature among the isolates. The infection could be managed favorably with medical treatment in all eyes.

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