Case Report: Successful Corneal Crosslinking in a Patient with Corneal Ectasia Associated with Stevens-Johnson Syndrome. Issue 1 (January 2021)

• Record Type: Journal Article
• Authors: Li, Ye; Lu, Lucy M.; Gokul, Akilesh; Ziaei, Mohammed
• Is Part Of: Optometry and vision science. Volume 98:Issue 1(2021)
• Publication Date: 2021-01
• Subjects: Optometry -- Periodicals; Physiological optics -- Periodicals; Vision disorders -- Periodicals; 617.7505
• DOI: 10.1097/OPX.0000000000001623
• Languages: English
• ISSNs: 1040-5488

Abstract

Abstract : SIGNIFICANCE: Corneal ectasia can be a complication of Stevens-Johnson syndrome. When detected in a timely manner, corneal crosslinking can be a safe treatment. This is an important association to highlight that early diagnosis and treatment can prevent the need for invasive surgical procedures such as keratoplasty. PURPOSE: This study aimed to report a successful accelerated epithelium-off corneal crosslinking in a rare case of corneal ectasia secondary to Stevens-Johnson syndrome. CASE REPORT: A 25-year-old Indian man presented with a progressive visual acuity decline 5 years after an acute episode of Stevens-Johnson syndrome secondary to penicillin ingestion. Serial tomography scans confirmed the diagnosis of corneal ectasia. After the preparation of the ocular surface, which was deemed to have a mild degree of limbal stem cell deficiency, with frequent preservative-free lubrication and steroid use, accelerated epithelium-off crosslinking was performed with 4 minutes of continuous ultraviolet-A exposure at 30 mW/cm 2 and a total energy dose of 7.2 J/cm 2 . Complete re-epithelialization was observed at 72 hours after crosslinking with no complications. Corneal tomography 15 months after treatment showed stabilization of ectasia, with improvement in visual acuity. CONCLUSIONS: Corneal ectasia is a rare but important complication of Stevens-Johnson syndrome. Accelerated epithelium-off crosslinking treatment can be considered in patients with a compromised ocular surface after Stevens-Johnson syndrome. Pre-operative optimization of the ocular surface and vigilant monitoring in the early post-operative period are recommended for the prevention of complications.