Corneal cross-linking for treatment of corneal ulcers
Reviewed by Bushra Thajudeen

This was an observational cohort study looking at the usefulness of photo activated chromophore for infectious keratitis-corneal collagen cross-linking (PACK-CXL) in reducing the time to heal in suppurative corneal ulcers. This study, conducted in a tertiary care centre in South India, had two arms; The prospective arm of 13 patients with suppurative corneal ulcers who underwent PACK – CXL and a retrospective cohort of 32 consecutive patients who had been admitted and treated at the same centre for a similar profile of ulcers in the previous one year. All patients aged between 18 and 75 years, with a corneal ulcer size of 2-6 mm (largest diameter) and a positive smear or culture for bacteria or fungus were included. Exclusion criteria were suspected viral keratitis, proven Acanthamoeba keratitis, ulcers with more than 50% corneal thinning on slit-lamp evaluation, patients with a history of previous PACK-CXL. All patients were treated with standard medical therapy who then underwent additional CXL (Dresden protocol) within 48 hours of admission. PACK-CXL was performed up to a maximum of four sessions, with an interval of 48 hours between therapy sessions. The study outcome parameters were either 1) healing (closure of epithelial defect) or 2) nonhealing (failed treatment) of ulcer. The mean number of days for the time to heal was 48.8 (SD, 36.7) days in the retrospective group and was 23.2 (SD, 14.3) days in the prospective group. A mean reduction from 48.8 to 23.2 days is clinically significant although not statistically significant. Four of the 32 patients (12.5%) in the retrospective cohort had treatment failure with one of the 11 (9.09%) in the cohort treated with PACK-CXL (p=0.97). The authors conclude that this pilot study suggests that PACK-CXL with more than one exposure may be a potential valuable addition to the management of patients with bacterial and fungal corneal ulcers.

PACK-CXL in reducing the time to heal in suppurative corneal ulcers: Observations of a pilot study from South India.
Basaiawmoit P, Selvin ST, Korah S.
CORNEA
2018;37(11):1376-80.