{Reference Type}: Review
{Title}: Management of corneal melting after collagen cross-linking for keratoconus: a case report and a review of the literature.
{Author}: Moramarco A;di Geronimo N;Gardini L;Grendele A;Fontana L;
{Journal}: BMC Ophthalmol
{Volume}: 24
{Issue}: 1
{Year}: 2024 Mar 25
{Factor}: 2.086
{DOI}: 10.1186/s12886-024-03400-1
{Abstract}: <B>OBJECTIVE: </B>We describe the management of a case of severe corneal melting after corneal cross-linking (CXL) treated with a staged approach using a conjunctival flap followed by deep anterior lamellar keratoplasty (DALK).<BR><B>METHODS: </B>A 12-year-old male developed severe corneal melting with pending perforation after an accelerated epithelium-off CXL protocol. We initially treated the patient with a conjunctival flap to prevent perforation. Three months later, we performed DALK to restore vision.<BR><B>RESULTS: </B>Conjunctival flap surgery allowed us to avoid corneal perforation and penetrating keratoplasty (PK) à chaud. Once the inflammation had resolved, we recessed the conjunctiva and performed DALK for optical purposes. Twelve months later, the graft was clear and the corrected visual acuity was 20/25 (Snellen). No complications occurred after surgery.<BR><B>CONCLUSIONS: </B>Although CXL is considered a safe procedure, in rare cases it can lead to serious complications, such as corneal haze, infectious and non-infectious keratitis, stromal melting and perforation. Corneal melting and perforation are usually managed by emergency PK. Herein we suggest a staged approach involving an emergency conjunctival flap followed by DALK at a later time that allowed us to avoid PK à chaud.