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Peripheral Sterile Corneal Ring Infiltrate After Riboflavin–UVA Collagen Cross-Linking in Keratoconus

Ghanem, Ramon C. MD, PhD; Netto, Marcelo V. MD, PhD; Ghanem, Vinícius C. MD, PhD; Santhiago, Marcony R. MD; Wilson, Steven E. MD

doi: 10.1097/ICO.0b013e318226da53
Case Report

Purpose: To present 7 cases of peripheral sterile corneal infiltrates that occurred after corneal cross-linking (CXL) for progressive keratectasia.

Methods: Seven patients who had their progressive keratoconus documented underwent corneal deepithelization and subsequently CXL, which was performed with the application of 0.1% riboflavin with 20% dextran, and exposure to UVA light (370 nm, 2.9–3.1 mW/cm2) for 30 minutes.

Results: Nearly a week after the procedure, the patients presented with peripheral stromal infiltrates. The ring-like infiltrates were superficial and were present at the 9.0-mm zone. Sterile infiltration was diagnosed. Patients were treated with topical corticosteroids, and complete resolution was achieved after a few weeks of treatment.

Conclusions: We hypothesize that the phototoxic effect on the corneal stroma may be the main mechanism that triggers these infiltrates. Alternatively, alterations in antigenicity that occur in native proteins after CXL could result in patients recognizing the proteins as nonself and mounting immune responses.

*Sadalla Amin Ghanem Eye Hospital, Joinville, Santa Catarina, Brazil

Department of Ophthalmology, University of São Paulo, São Paulo, Brazil

Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH.

The authors state that they have no financial or conflicts of interest to disclose.

Reprints: Ramon C. Ghanem, Sadalla Amin Ghanem Eye Hospital, 172 Abdon Batista St, Joinville, Santa Catarina 89201, Brazil (e-mail:

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.