Comparison of modified corneal cross-linking with intrastromal voriconazole for the treatment of fungal corneal ulcer

Abstract

The present study aimed to evaluate the efficacy of modified corneal cross-linking (CXL) for the treatment of fungal corneal ulcers compared with that following intrastromal voriconazole injection. In total, 31 patients with fungal corneal ulcers treated at The General Hospital of Northern Theater Command between October 2017 and October 2019 were enrolled. Among them, 10 eyes were treated with ultraviolet A (UV-A)/riboflavin CXL (CXL group), whilst 21 eyes were treated with debridement combined with intrastromal voriconazole (stromal injection group). Preoperative microbiological examination was performed in both groups, and evaluated using Fisher's exact test. Postoperatively, infection control and total efficacy rates, localized lesion, ulcer healing rate 1 week after surgery, visual acuity and complications were evaluated using Fisher's exact test, however visual acuity was analyzed by mixed-model ANOVA. The results showed that the pre-operative species distribution between the CXL and stromal injection groups did not significantly differ. The infection control rate in the CXL group was notably higher compared with that in the stromal injection group (P= 0.04). Furthermore, the total efficacy rate in the CXL group was also markedly higher compared with that in the stromal injection group, though no statistically significant differences were observed. Localized lesions were observed in nine eyes (90.0%) in the CXL group and nine eyes (42.9%) in the stromal injection group (P= 0.02). However, the rate of ulcer healing at 1 week postoperatively and the logarithm of the minimum angle of resolution (logMAR) of visual acuity were not found to be significantly different between the two groups. In terms of complications, with the exception of one patient in the CXL group exhibiting loss of corneal transparency and one patient in the stromal injection group presenting with partial corneal thinning, no other forms of complications were observed. In conclusion, the present study suggested that CXL could have a beneficial impact for treating fungal corneal ulcers in the aspects of infection control, localized lesions and accelerated epithelialization. In addition, except the loss of corneal transparency, this treatment approach could be applied with reduced risks of adverse events.

Local application of silver nitrate as an adjuvant treatment before deep lamellar keratoplasty for fungal keratitis poorly responsive to medical treatment

“…Effective treatment was defined as partially healed ulcers, alleviated inflammatory responses, relieved lesions, and no fungal hyphae or reduction in hyphae, and reduction of empyema in the anterior chamber. Ineffective treatment was defined by increased numbers of fungal hyphae, aggravated area and depth of the ulcer ( 10 ), and increase in empyema in the anterior chamber.…”

Therapy for contact lens-related ulcers

“…PACK-CXL in conjunction with topical therapy has shown success in bacterial keratitis but less so in fungal keratitis [83][84][85]. Although some studies have shown it equivalent to intrastromal voriconazole [86], others have shown an increased risk of perforations and an increased need for therapeutic keratoplasty [87]. Future larger studies are required to determine a more consistent answer.…”