case_images: PMC4899655_01
case_images: Corneal melting and perforation after corneal CxL for KC associated with nepafenac eye drop use in a diabetic patient. a Corneal topography before corneal CxL, showing inferior steepening typical of KC. b Paracentral corneal melting and thinning with a large perforation and iris prolapse 6 weeks after corneal CxL and topical nepafenac use. c Histologic evaluation of the excised cornea revealing inflammatory cells and loss of stroma associated with the corneal melting and pigmented cells associated with iris contact with the cornea. In this section, the epithelium is preserved, because the descemetocele was epithelized in the areas surrounding the perforation and iris prolapse. d Clear cornea 1 month after successful tectonic PKP, extracapsular cataract extraction, intraocular lens implantation and pupilloplasty.
case_images: cop-0007-0119-g01.jpg
case_images: PMC4899655_01_cop-0007-0119-g01.jpg
case_images: F1
case_images: Orbscan topographer (fig. 1a). On inquiry by the ophthalmologist that had performed the procedure, corneal CxL had been conducted according to the Dresden protocol, using hypotonic riboflavin 0.1% (Ricrolin-TE ; SOOFT, Montegiorgio, Italy) and the VEGA CBM X-Linker (CSO Ophthalmic, Florence, Italy). On examination, her left eye revealed hyperemia, paracentral corneal melting (5 x 5 mm) with corneal thinning, corneal perforation (2 x 2 mm), iris prolapse, and a positive Seidel test (fig. 1b). Histologic evaluation of the excised button revealed fibrosis, chronic inflammation and stroma loss associated with corneal thinning (fig. 1c); no microorganisms were isolated from cultures of the excised cornea. One month after PKP, the tectonic graft was clear, uncorrected visual acuity was 20/200, and pinhole visual acuity was 20/60 (fig. 1d).