Evaluation of corneal collagen cross-linking as an additional therapy in mycotic keratitis

BackgroundTo report the treatment outcomes of mycotic keratitis with collagen cross-linking. DesignRetrospective study. ParticipantsPatients with smear-positive moderate mycotic keratitis. MethodsA retrospective case-file analysis was performed to identify cases of moderate mycotic keratitis treated with and without additional collagen cross-linking, in addition to intensive topical antifungal therapy. Patients in which collagen cross-linking was performed on the day of presentation (group 1) were compared with patients who received medical treatment alone in the form of 5% natamycin eye drops (group 2). Main Outcome MeasuresThe primary outcome measure was the time taken for resolution of infection. ResultsOverall, 41 cases were included for analysis (group 1, 20 cases; group 2, 21 cases). Mean age of the patients was comparable in both groups (46.517.01 vs. 41.2 +/- 20.7 years; P=0.36). Average infiltrate size was 16.35 +/- 6.8mm(2) in group 1 and 17.09 +/- 7.4mm(2) in group 2 (P=0.83). Overall, Aspergillus was the most commonly isolated organism (n=4 group 1; n=6 group 2). Resolution of infection was observed in 18 cases (90%) in group 1 and 18 (85.71%) cases in group 2. The average healing time was 30.85 +/- 26.6 days in group 1, while it was 31.28 +/- 19.97 days in group 2 (P=0.94). Final best-corrected visual acuity in group 1 was 1.13 +/- 0.55 and 1.25 +/- 0.46 in group 2 (P=0.46). A tectonic keratoplasty was performed in two cases in group 1 and three cases in group 2 (P=1.00). ConclusionsIn our study, additional collagen cross-linking treatment did not have any advantage over medical management in cases with moderate mycotic keratitis.