CXL appears effective for advanced microbial keratitis

This prospective study found that corneal collagen cross-linking (CXL) appears to be effective for managing nonresolving microbial keratitis.

This study evaluated 15 eyes of patients with infectious keratitis. After experiencing no improvement with two weeks of topical therapy, they underwent CXL with riboflavin. 

Pain resolved in all 15 patients on postoperative day one. After CXL treatment, symptoms resolved in six of the nine patients with bacterial keratitis and three of the six patients with fungal keratitis. Patients with deep stromal keratitis or endothelial plaque failed to resolve.

There was an increase in hypopyon in four patients post-CXL, and hypopyon appeared in three patients. The authors thought this was due to riboflavin penetration into the anterior chamber.

They conclude that CXL can be an effective adjunctive treatment for managing resistant microbial keratitis. However, further studies are required to streamline the indications, protocol and safety profile of CXL for microbial keratitis.

Discussion question: At what point in treatment would you consider adjunctive CXL for patients with infectious keratitis?