Diclofenac-induced acute corneal melt after collagen crosslinking for keratoconus.

PURPOSE We report a case of acute corneal melt with perforation in a patient with keratoconus after collagen crosslinking treatment and the use of topical diclofenac and proparacaine eyedrops. METHODS The authors present a case report with clinicopathologic correlation. RESULTS A patient diagnosed with keratoconus underwent corneal collagen crosslinking followed by postoperative use of ofloxacin, dexamethasone, diclofenac, and proparacaine eyedrops. He presented 1 week later with corneal melt and perforation and was treated initially with tissue glue and bandage contact lens application followed by a penetrating keratoplasty on Day 12. The graft was clear at 1 month. A histologic examination revealed corneal perforation with surrounding stromal loss and inflammatory infiltrates. CONCLUSION Use of diclofenac sodium and proparacaine eyedrops after surgery was possibly responsible for the corneal melt in our patient. Patients who have undergone crosslinking treatment should be observed closely until the corneal epithelium heals completely.