RESUMO
PURPOSE: To investigate the efficacy of photoactivated chromophore corneal collagen cross-linking (PACK)-CXL in the management of treatment-resistant infectious keratitis. DESIGN: Observational cohort study. PARTICIPANTS: Forty-two eyes from 41 patients with treatment-resistant infectious keratitis. METHODS: Eyes underwent PACK-CXL treatment with the Dresden modified protocol in addition to standard antimicrobial therapy. The primary endpoint was the size of the corneal ulcer. Descriptive statistics, Wilcoxon rank test, McNemar test and Spearman correlation coefficient were used for statistical analysis, and p values lower than 0.05 were considered statistically significant. RESULTS: Success rate at third postoperative month was of 90.5%. Statistical analyses showed a significant effect of (PACK)CXL with standard antimicrobial therapy to reduce corneal ulcer size (p=0.031). CONCLUSION: As adjuvant therapy to standard antimicrobial treatment, PACK-CXL improves the outcomes in patients with treatment-resistant corneal ulcers.
RESUMO
Fungal keratitis is an ocular infection that has no standardized treatment. The etiological agents most frequently reported in the literature are Fusarium spp., Aspergillus spp., Alternaria spp. and Curvularia spp., related to injuries and Candida albicans related to contact lens wear. Here we present a case of bilateral fungal keratitis of a few days of evolution with insufficient response to antifungal pharmacological treatment and with early application of cross-linking in both eyes as an adjuvant therapy. A review of the current status of cross-linking for the treatment of corneal infections is presented.