Significant visual increase following infectious keratitis after collagen cross-linking.

PURPOSE: To report a patient who developed a left paracentral stromal scar due to infectious keratitis that occurred after corneal collagen cross-linking (CXL) for progressive keratoconus. The flattening effect of the scar led to an increase in visual acuity.

METHODS

The corneal scar and flattening effect on the anterior corneal curvature were assessed by slit-lamp photography, high-resolution Scheimpflug imaging, and corneal confocal microscopy.

RESULTS

Three days after CXL, a corneal bacterial infection occurred in the left cornea and was treated with local antibiotics that led to a paracentral scar. Twenty-one days after CXL, a flattening of the anterior curvature of >11.00 diopters was observed. As a consequence, corrected distance visual acuity improved by five lines.

CONCLUSIONS

Corneal remodeling may lead to a homogenization of the anterior corneal surface and an increase in visual acuity. Remodeling may not only occur spontaneously following CXL, but also following an event that results in focal corneal scarring, such as corneal infection. In a highly irregular keratoconic cornea, the benefit of the flattening effect of a scar may outweigh the increase in aberrations and light scatter.