Corneal Cross-linking as an Adjuvant Therapy in the Management of Recalcitrant Deep Stromal Fungal Keratitis: A Randomized Trial

• Published in: American journal of ophthalmology 2015-07, Vol.160 (1), p.131-134.e5
• Main Authors: Uddaraju, Madhu, Mascarenhas, Jeena, Das, Mano Ranjan, Radhakrishnan, Naveen, Keenan, Jeremy D, Prajna, Lalitha, Prajna, Venkatesh N
• Format: Article
• Language: English
• Subjects: Administration, Topical; Adult; Antifungal Agents - therapeutic use; Clinical trials; Collagen - metabolism; Combined Modality Therapy; Cornea - metabolism; Cornea - microbiology; Corneal Perforation - etiology; Corneal Perforation - surgery; Corneal Ulcer - drug therapy; Corneal Ulcer - microbiology; Cross-Linking Reagents - adverse effects; Eye Infections, Fungal - drug therapy; Eye Infections, Fungal - microbiology; Female; Fungi - isolation & purification; Humans; Male; Medical treatment; Microscopy; Microscopy, Confocal; Middle Aged; Natamycin - therapeutic use; Ophthalmic Solutions; Ophthalmology; Photosensitizing Agents - therapeutic use; Riboflavin - therapeutic use; Ultraviolet Rays; Vitamin B; Voriconazole - therapeutic use
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2015.03.024

Purpose To assess the efficacy of corneal cross-linking (CXL) as an adjuvant to appropriate antifungal therapy in nonresolving deep stromal fungal keratitis. Design Randomized clinical trial. Methods Eyes with culture-positive deep stromal fungal keratitis not responding to appropriate medical therapy for a period of 2 weeks were randomized to receive either adjuvant CXL or no additional treatment. Antifungal medical therapy was continued in both groups. The prespecified primary outcome was treatment failure at 6 weeks after enrollment, defined as perforation and/or increase in ulcer size by ≥2 mm. Results The trial was stopped before full enrollment because of a marked difference in the rate of perforation between the 2 groups. Of the 13 cases enrolled in the study, 6 were randomized to the CXL group and 7 to the non-CXL group. Five eyes in the CXL group and 3 eyes in the non-CXL group experienced treatment failure by 6 weeks ( P  = .56). In a secondary analysis, the CXL group experienced more perforations than the non-CXL group (4 vs 0, respectively; P  = .02). Conclusion CXL used as adjuvant therapy for recalcitrant deep stromal fungal keratitis did not improve outcomes.