Acute corneal melt and perforation - A possible complication after riboflavin/UV-A crosslinking (CXL) in keratoconus.

Purpose: To report two cases of acute corneal melting and perforation requiring emergency penetrating keratoplasty after corneal crosslinking (CXL) in advanced keratoconus.

Observations: Case 1 was a 34 and case 2 was a 16-year old male, both with progressive keratoconus, who underwent CXL (Dresden protocol). After riboflavin imbibition, patients had a minimal pachymetry of 337 μm and 347 μm, and therefore required stromal swelling by hypoosmolar riboflavin resulting in pachymetries of 470 μm and 422 μm, prior to the 30 minute UV-irradiation with 3mW/cm.