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Endothelial Failure After Collagen Cross-Linking With Riboflavin and UV-A: Case Report With Literature Review

Bagga, Bhupesh FRCS; Pahuja, Shivani MS; Murthy, Somasheila MS; Sangwan, Virendra S. MS

doi: 10.1097/ICO.0b013e31823cbeb1
Case Report

Purpose: To report a case of endothelial decompensation after a collagen cross-linking (CXL) procedure for keratoconus.

Methods: An 18-year-old boy had CXL for keratoconus in the right eye. He developed keratouveitis with generalized corneal edema seen 3 weeks after the procedure. Polymerase chain reaction for aqueous humor Herpes simplex virus was negative. The patient was treated with topical steroids. Specular microscopy revealed mildly reduced density of endothelial cells. On follow-up to 6 months, corneal edema increased with the formation of epithelial bullae. Penetrating keratoplasty was performed. Possible causes for this complication are discussed.

Results: Clinical and histopathological analyses revealed generalized loss of endothelial cells along with signs of inflammation.

Conclusions: Although it is considered very safe, collagen CXL can cause severe keratouveitis and endothelial failure.

Cornea and Anterior Segment Department, L.V. Prasad Eye Institute, Hyderabad, India.

Reprints: Bhupesh Bagga, Cornea and Anterior Segment Department, L. V. Prasad Eye Institute, Hyderabad 500034, India (e-mail:

The authors declare that they have no financial interest.

The authors state that they have no proprietary interest in the products named in this article.

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