Fungal Infection Post Corneal Cross Linking, Case Record Ahmed Sedky, FRCOphth, Cairo, Egypt The author of this poster have received consultant reimbursement from WaveLight Laser Technologies. The author has no financial interest in the subject matter of this poster.

Pre-Cross linking 24 years old female, BCVA 20/50 Topography = Keratoconus grade 2 Pachymetery Map, 510 Microns 2A.Sedky,FRCOphth,Cairo,Egypt

4 days post X-Linking White Elevated mass with corneal ulceration 3 A.Sedky,FRCOphth,Cairo,Egypt

What happened???? 4 A.Sedky,FRCOphth,Cairo,Egypt

Fungal or microbial infection? Deep Corneal vessles 360 degrees 5 A.Sedky,FRCOphth,Cairo,Egyp t

Or excessive Riboflavin???? Patient in severe pain, UCVA is HM 6 A.Sedky,FRCOphth,Cairo,Egypt

Two weeks post X-Linking, Scraping was done Lab test = Negative 7A.Sedky,FRCOphth,Cairo,Egypt

One week after scraping Re-formation of the same elevated white mass 8 A.Sedky,FRCOphth,Cairo,Egypt

Corneal cross section Pentacam Shows thickened elevated mass 9 A.Sedky,FRCOphth,Cairo,Egypt

Patient Follow Up One Month post X-linkingTwo months post X-linking 10A.Sedky,FRCOphth,Cairo,Egypt

Patient Follow Up 3 months, healing is better, corneal vessels are less 4 months, healed, white opacity, Corneal vessels regressed, PKP is done 11A.Sedky,FRCOphth,Cairo,Egypt

Conclusion Do we need some sort of a Nomogram for CCL? Do we have to use the same amount of Riboflavin for all corneal diameter? Do we have to use the same amount of Riboflavin for all corneal thickness? 12A.Sedky,FRCOphth,Cairo,Egypt