[2026-09-24] Sterile Corneal Infiltrates Following Corneal Cross-Linking in Keratoconus: A Case Report

Abstract

Background: Corneal cross-linking (CXL) is currently the only established intervention that halts the progression of keratoconus (KCN). Common complications include infection, corneal haze, stromal scarring, and treatment failure. This presented an uncommon case of sterile corneal infiltrates occurring after uneventful accelerated CXL.

Case Presentation: A 21-year-old Thai male patient with progressive KCN in the right eye, indicated by an increase in maximum keratometry and reduction in thinnest pachymetry, underwent epithelial-off CXL using accelerated VibeX Rapid protocol. A bandage contact lens was placed postoperatively. On postoperative day 3, slit-lamp examination revealed multifocal whitish subepithelial infiltrates along the margin of the irradiation zone from 5 to 10 o’clock, with a clear intervening zone adjacent to the limbus. The corneal epithelium was intact. Sterile infiltrates were suspected; however, infectious keratitis could not be completely excluded. Broad-spectrum topical antibiotics were initiated and rapidly tapered once infection was deemed unlikely. Topical fluorometholone was subsequently added twice daily. The infiltrations resolved completely within one month, leaving faint anterior stromal scarring that did not affect the visual acuity.

Conclusions: Sterile corneal infiltrations after CXL in KCN typically present as peripheral multifocal subepithelial infiltrations along the epithelial debridement margin without epithelial defects. Corneal infection must be excluded before corticosteroid therapy. Prompt recognition and appropriate management result in excellent visual prognosis.