Corneal CXL as Adjunct in Initial Treatment of Vision-Threatening Infectious Keratitis

Saturday, April 26, 2014: 1:06 PM
Room 151B (Boston Convention and Exhibition Center)
Mustafa Kapasi, MD, University of Ottawa Eye Institute, Ottawa, ON, Canada
Ronan J. Conlon, MD, University of Ottawa, Ottawa, ON, Canada
Salina Teja, MD, University of Ottawa Eye Institute, Ottawa, ON, Canada
Kashif Baig, MD, MBA, Ottawa Eye Institute, Ottawa, ON, Canada

Narrative Responses:

Purpose
The purpose of this study is to determine the efficacy of corneal collagen cross-linking as an adjunct to topical antimicrobial therapy as a first-line treatment for sight-threatening central corneal ulcers.

Methods
The study is a single centre, prospective randomized trial. Twenty patients with vision threatening central corneal ulcers were identified and randomly allocated into one of two treatment arms: corneal collagen crosslinking followed by fortified antibiotics; or fortified antibiotics alone. The primary outcome measure of this study was time to re-epithelialization, which was measured using slit-lamp biomicroscopy. The secondary outcome measure was time to resolution of the infiltrate. Descriptive and inferential statistics were performed.

Results
Time to re-epitheliazation was 19.8 (standard deviation (SD) 7.7, 95% confidence interval (CI) 11.8 – 27.9) and 29.4 (SD 5.5, 95% CI 22.6 – 36.2) for the CXL/antibiotics and antibiotics only groups, respectively. A two-tailed unpaired t-test showed a statistically significant shorter time to re-epithelization in the CXL/antibiotics group (p = 0.044). The visual acuity (VA) was converted to logMAR for analysis. The difference was calculated by subtracting the initial VA from the VA at the time of re-epitheliazation. Mean logMAR difference in VA in the CXL/antibiotics group was -0.037 (SD 0.56, 95% CI 1.5-1.4) and mean logMAR difference in VA in the antibiotics only was -0.364 (SD 0.73, 95% CI 2.4-1.7). These values were not statistically significantly different (p = 0.73).

Conclusion
Our data indicates that CXL for infectious ulcerative keratitis is superior to antibiotic therapy alone in the management of vision threatening corneal ulcers.