Atypical sterile infiltrates after corneal crosslinking

Introduction: 3 cases of atypical sterile opacifications during the early-postoperative phase after corneal crosslinking (CXL) have been described. Patient and Clinical Findings: On a routine follow-up 4 days after CXL, sterile anterior stromal opacifications were observed on slitlamp examination of patients with keratoconus (KC). Their presentations ranged from a crescentic opacification located at the margin of the irradiation zone at a depth of 270 μm (Case 1) to a peripheral well-delineated, disc-shaped opacification (Case 2) to disseminated multifocal infiltrates (Case 3). All reported eyes had completely healed epithelium with the onset of opacifications, more than 24 hours after CXL. After an interval of 6 months, only minor changes on slitlamp biomicroscopy were observed in each case, and optical coherence tomography was suggestive of a scar formation. Diagnosis, Intervention, and Outcome: The occurrence of these sterile infiltrates in KC eyes with thinnest pachymetry superior to 400 μm and their shape, location, and depth were remarkable. These infiltrates were labeled as atypical because they failed to respond to topical steroids and resulted in scar formation. Conclusions: A collection of atypical sterile anterior stromal infiltrates originating from the very early-postoperative course after accelerated or customized CXL have been reported.