Corneal Collagen Cross-Linking for the Management of Mycotic Keratitis.

Purpose: To evaluate the efficiency of corneal collagen cross-linking (CXL) in addition to topical voriconazole in cases with mycotic keratitis.Design: Retrospective case series in a tertiary university hospital.Participants: CXL was performed on 13 patients with mycotic keratitis who presented poor or no response to topical voriconazole treatment.Methods: The clinical features, symptoms, treatment results and complications were recorded retrospectively. The corneal infection was graded according to the depth of infection into the stroma (from grade 1 to grade 3). The visual analogue scale was used to calculate the pain score before and 2 days after surgery.Main Outcome Measures: Grade of the corneal infection.Results: Mean age of 13 patients (6 female and 7 male) was 42.4 ± 17.7 years (20-74 years). Fungus was demonstrated in culture (eight patients) or cytological examination (five patients). Seven of the 13 patients (54%) were healed with topical voriconazole and CXL adjuvant treatment in 26 ± 10 days (15-40 days). The remaining six patients did not respond to CXL treatment; they initially presented with higher grade ulcers. Pre- and post-operative pain score values were 8 ± 0.8 and 3.5 ± 1, respectively (p < 0.05).Conclusions: The current study suggests that adjunctive CXL treatment is effective in patients with small and superficial mycotic ulcers. These observations require further research by large randomized clinical trials. [ABSTRACT FROM AUTHOR]