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

Madhu Uddaraju, Jeena Mascarenhas, Mano Ranjan Das, Naveen Radhakrishnan, Jeremy D Keenan, Lalitha Prajna, Venkatesh N Prajna

Journal: American journal of ophthalmology 2015;160(1):131-4.e5

PMID: 25841317

Full Text on Elsevier Science View on PubMed

Abstract

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.

Address: Aravind Eye Hospital, Madurai, Tamilnadu, India.; Francis I. Proctor Foundation and Department of Ophthalmology, University of California, San Francisco, San Francisco, California.; Aravind Eye Hospital, Madurai, Tamilnadu, India. Electronic address: [email protected].

DOI: 10.1016/j.ajo.2015.03.024

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MeSH Terms: Administration, Topical, Adult, Antifungal Agents, Collagen, Combined Modality Therapy, Cornea, Corneal Perforation, Corneal Ulcer, Cross-Linking Reagents, Eye Infections, Fungal, Female, Fungi, Humans, Male, Microscopy, Confocal, Middle Aged, Natamycin, Ophthalmic Solutions, Photosensitizing Agents, Riboflavin, Ultraviolet Rays, Voriconazole