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