This article is more than 5 years old. Information may no longer be current.
Cross-linking successfully treats microbial keratitis in study
Click Here to Manage Email Alerts
Corneal cross-linking can be used as an adjunctive treatment for nonresolving microbial keratitis and as primary treatment for superficial keratitis, according to the results of a recent study.
Shetty and colleagues evaluated 15 eyes of 15 patients with microbial keratitis, according to a study published in the British Journal of Ophthalmology. Nine patients had bacterial keratitis and six had fungal keratitis. All patients were treated with antibiotics/antifungals, and those who did not respond to at least 2 weeks of therapy were administered corneal cross-linking treatment. The same medications were continued after the procedure, and the patients were evaluated every third day.
The researchers reported that the keratitis resolved in six of the nine patients with the bacterial type and three of the six patients with the fungal type. Those conditions that did not resolve involved deep stromal keratitis or endothelial plaque.
“In patients undergoing therapeutic keratoplasty for nonhealing microbial keratitis, approximately a third of transplanted grafts become re-infected,” the researchers wrote. “There has, therefore, been a constant quest to find an alternative to therapeutic keratoplasty when medical management fails.
“Corneal cross-linking appears to be an effective procedure in treating nonresolving microbial keratitis with superficial stromal involvement,” they concluded. “It can be an effective adjunctive treatment and add to the armamentarium of treatment modalities in the management of resistant microbial keratitis.”
Perspective
Back to Top
Scott G. Hauswirth, OD, FAAO
The Shetty study echoes others in the literature that have overall been supportive of the antimicrobial activity of riboflavin-UVA crosslinking. Although the n is relatively low, the sample represents a broad continuum of keratitis and helps to draw some important trends – namely, that there was greater success at treating keratitis when only the anterior third of the stroma was involved. This points to a potentially greater benefit when treatment is utilized earlier.
With increasing resistance of organisms to pharmaceutical antimicrobial therapy, utilizing cross-linking to treat these ulcers at an earlier stage prior to deep stromal involvement would give another tool to combat infections and prevent them from getting to the stage where more invasive surgical procedures are needed. In addition, the authors mention that they have demonstrated success at preventing melts from organisms such as Pseudomonas, alluding to the improved resistance to collagenase activity by the corneal stroma, which cross-linking has been shown to induce. Anecdotally, in our practice we have treated a number of difficult infectious keratitis with cross-linking and have had similar results.
In summary, the Shetty paper is yet another argument to have this as an FDA-approved technology here in the U.S.
Collapse
Br J Ophthalmol. 2014;doi:10.1136/bjophthalmol-2014-304944.
Click Here to Manage Email Alerts