case_images: PMC5745696_01
case_images: Clinical appearance of the patient before surgery. Please note a corneal perforation surrounded by a dense infiltrate (A) associated with inferior neovascularization (B).
case_images: CRIOPM2017-6987896.001.jpg
case_images: PMC5745696_01_CRIOPM2017-6987896.001.jpg
case_images: fig1
case_images: There was an almost complete shallowing of the anterior chamber and a cataract (Figure 1).
case_images: Simultaneous noncentered photoactivated chromophore for keratitis-corneal collagen cross-linking (PACK-CXL) and penetrating keratoplasty. (a) Corneal trephination. (b) Cornea removal. (c) Open-sky cataract removal. (d) Intraocular lens implantation. (e) Donor cornea suturing. (f) Riboflavin impregnation.
case_images: CRIOPM2017-6987896.002.jpg
case_images: PMC5745696_01_CRIOPM2017-6987896.002.jpg
case_images: fig2
case_images: Surgery (Figure 2) was performed by one of the authors (K.B.) under general anesthesia: donor and receptor corneas were cut with an 8.50 mm and 8.00 mm trephine, respectively.
case_images: Cross-linking lamp used for the treatment of the patient (UV-X 2000, Avedro Inc., Waltham, United States).
case_images: CRIOPM2017-6987896.003.jpg
case_images: PMC5745696_01_CRIOPM2017-6987896.003.jpg
case_images: fig3
case_images: Irradiation with ultraviolet was performed with a CXL machine (UV-X 2000 , Avedro Inc., Waltham, United States) (Figure 3) for ten minutes, aiming for an energy dose of 9 mW/cm2.
case_images: Schematic representation of the areas of the eye covered by the penetrating keratoplasty procedure (blue circle, 8 mm) and the noncentered PACK-CXL (green circle, 7 mm).
case_images: CRIOPM2017-6987896.004.jpg
case_images: PMC5745696_01_CRIOPM2017-6987896.004.jpg
case_images: fig4
case_images: UV irradiation beam was positioned so that it included part of the donor cornea, the whole infected receptor cornea, affected limbus, and a small part of sclera (Figure 4).
case_images: Clinical appearance of the patient three weeks after surgery. Note some natamycin over the eye.
case_images: CRIOPM2017-6987896.005.jpg
case_images: PMC5745696_01_CRIOPM2017-6987896.005.jpg
case_images: fig5
case_images: Due to the patient's economic status and insurance, he could only start antibiotic and antifungal treatment about 21 days after surgery (Figure 5).
case_images: Clinical appearance of the patient two months after surgery, showing a complete resolution of infection, with conjunctivalization replacing the area that was infected in the receptor rim.
case_images: CRIOPM2017-6987896.006.jpg
case_images: PMC5745696_01_CRIOPM2017-6987896.006.jpg
case_images: fig6
case_images: During the follow-up period (over four months) the patient has shown an excellent recovery; his eye inflammation has been as expected for a penetrating keratoplasty, and no clinical signs of infection recurrence have been noted (Figure 6).