Infectious keratitis responds to riboflavin crosslinking

Chicago-Corneal collagen crosslinking (CXL) with ultraviolet A (UVA) light and riboflavin is promising therapy for infectious keratitis caused by a variety of pathogens, said J. Bradley Randleman, MD.

“More study is needed, and there are a number of questions to be answered,” said Dr. Randleman, associate professor of ophthalmology, Emory University, Atlanta. “However, CXL is exciting, in part because it may also be beneficial for preventing corneal melting in more severe cases and for its implications for improving outcomes where compliance with antibiotic therapy is a potential concern.”

The ability to eradicate pathogens and protect the cornea while doing so by increasing corneal strength and resistance to collagen enzymatic degradation provides the rationale for interest in using CXL as a treatment for infectious keratitis. In vitro experiments have confirmed that the technique is effective against most bacteria and fungi, and independent authors have reported on its efficacy in clinical use for treating infectious keratitis of varying etiologies, including in cases of treatment-resistant Acanthamoeba keratitis. In a pilot study investigating CXL as primary therapy for microbial keratitis, Mortensen et al. reported complete resolution after a single treatment in 14 of 16 eyes.

Questions that need to be answered include whether CXL should be used as a primary intervention or reserved for eyes that have failed antibiotic therapy, if it can be used as solo treatment or should be adjuvant therapy, and whether it is repeatable if a first treatment fails.

In addition, further research is needed to determine the optimal UVA fluence and time.

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