Corneal Collagen Crosslinking for the Treatment of Microbial Keratitis

Introduction: Collagen cross-linking (CXL) is a new horizon in the treatment of corneal diseases.The corneal stroma is the thickest part of the cornea and is mainly composed of collagen fibrils,charged with stromal maintenance and wound healing. CXL by using UV rays and riboflavin could actas a photo mediator to inactivate pathogens in plasma, platelets, and red blood cells. Riboflavin alsoinduces a change in properties of the collagen and has a stiffening effect on the corneal stroma,which stabilizes it and increases its resistance to enzymatic bacteria degradation avoiding theprogression of corneal melting this study aimed to assess the efficacy and safety of corneal collagencross-linking (CXL) in the management of infectious keratitis. Patients and methods: This study isprospective Interventional Non-comparative case series and included 16 eyes of 16 patients withclinical and lab (direct smear, culture, and sensitivity) evidence of microbial keratitis who attended theoutpatient Cornea Unit, Ophthalmology department, Faculty of Medicine in Assiut University Hospital,Assiut. Data collected were detailed history and complete eye examination, including uncorrectedvisual acuity (UCVA), slit-lamp biomicroscopy, fundus examination, and intraocular pressuremeasurement for all patients. Results: Baseline visual acuity was in form of hand motion in 6(37.5%) patients and bad perception of light (PL) in 5 (31.3%) patients. Follow-up visual acuitywas in form of good PL IN 4 (25%) patients and 1m/60 in 3 (18.8%) patients. There was a significantimprovement in the visual acuity during follow-up in comparison to baseline visual acuity (2.83 ±0.70 vs. 1.93 ± 0.84; P< 0.001). Conclusion: CXL appears to be an effective procedure in treatingnon-resolving microbial keratitis with superficial stromal involvement. The most promising resultspublished so far are for keratitis especially when the germs do not involve the posterior stromaand in cases of impending perforation.