Corneal cross linking and infectious keratitis: a systematic review with a meta-analysis of reported cases

Abstract

BackgroundCollagen cross linking (CXL) of the cornea has been developed recently as a new treatment for multidrug-resistant infectious keratitis. The aim of this study is to summarize the previously published data and evaluate the effectiveness of this treatment.ResultsThe search identified 12 articles. The number of eyes was 104. The infectious keratitis was associated with bacteria in 58 eyes (57f%): Gram-positive bacteria in 44 (43%; 4 of which were infected with Mycobacterium (3.6%)) and Gram-negative bacteria in 14 eyes (13%), fungus in 13 eyes (12%), and Acanthamoeba in 7 eyes (7%). In 26 eyes (25%), the microbiological culture was negative or not performed. The mean time of re-epithelization after CXL was 20.7±28.1 days (minimum of 3, maximum of 145). Sixteen eyes underwent deep or lamellar keratoplasty. The pooled analysis suggested that CXL has a favorable effect on the block of corneal melting in 85% (95%; CI 0.77, 0.91) of eyes.ConclusionAlthough randomized controlled trials are needed, the available evidence supports the use of CXL in the treatment of infectious keratitis.

UV light crosslinking regresses mature corneal blood and lymphatic vessels and promotes subsequent high-risk corneal transplant survival

“…Furthermore, UV radiation itself can damage both DNA and RNA of pathogens and is used as an antimicrobial procedure 22. Recently, CXL with the interaction of riboflavin and UV irradiation was reported to also be used in corneal infections 23, 24, 25. After the topical application of riboflavin and UVA light, the reaction causes the release of very reactive singlet oxygen and other reactive oxygen radicals, which leads to apoptosis of, for example, keratocytes in the cornea 26, 27, 28.…”

Collagen cross-linking in recalcitrant corneal ulcers: A case series

“…In his case series, more than one session of CXL was performed in all the cases in comparision to our study in which only a single session of CXL was performed. Nepal J Ophthalmol 2016;8(15): 47-53 A meta-analysis of 12 articles was also conducted by Alio et al (2013) in which they reviewed 104 cases of corneal ulcer treated with CXL. The analysis proved that the suggested therapy had a favorable result in 85% of cases and 15% (16 cases) required keratoplasty.…”

“…Secondly, direct intercalation of the chromophore to the DNA of the pathogen, causing irreversible binding and suppression of replication. It also strengthens the cornea by changing 3 dimensional structures of collagen fibres (Alio JL et al, 2013) and increasing corneal resistance to degradative enzymes (Spoerl E et al, 2004). Another potential advantage of CXL is its toxic effect on inflammatory cells which may limit the inflammatory response to infectious organism (Wang F, 2008).…”

Modern treatments for purulent corneal ulcers

“…Помимо этого, по мнению ряда авторов, КРЛ воздействует непосредственно на бактериальные ферменты, замедляя их действие и частично их де-зактивируя [17].…”