Accelerated corneal crosslinking to treat Acanthamoeba and Fusarium coinfection of the cornea

Abstract

A 44-year-old man presented with Acanthamoeba and Fusarium coinfection keratitis. Fifteen years before, he had hyperopic laser in situ keratomileusis, and the coinfection was under the flap. The keratitis was nonresponsive to topical and systemic therapy; therefore, accelerated corneal crosslinking (CXL) with photoactivated riboflavin (photoactivated chromophore for keratitis) was performed to prevent a corneal perforation. After the treatment, there was unexpected rapid corneal melting with subsequent perforation. A reconstructive penetrating keratoplasty was promptly performed and was effective in resolving the coinfection. The current protocol for the application of photoactivated riboflavin CXL should be improved, and clinical criteria for applying this technique are required. Photoactivated riboflavin CXL might be an effective alternative to conventional agents in some cases of fungal and/or amoeba keratitis. However, in cases of deep stromal infections on previous surgically treated anterior stroma, it should not be considered a viable option.