title: Corneal cross-linking as supplementary treatment option in melting keratitis: a case series.
abstract: BACKGROUND
  Corneal melting represents a serious condition that can result in corneal perforation and loss of vision. Treatment options include topical and systemic immunosuppression, cyanoacrylate gluing, and emergency keratoplasty, depending on the underlying disease and the stage of corneal melt. Recently, corneal cross-linking (CXL) has emerged as an additional treatment option. The present study evaluates whether CXL induces a clinical improvement in melting keratitis not responding to conventional treatment.
  
  
  METHODS
  Six patients undergoing CXL for corneal melting of variable origin (including bacterial, fungal and Acanthamoeba keratitis) were reviewed retrospectively.
  
  
  RESULTS
  Treatment parameters included riboflavin application following UV irradiation with a wavelength of 370 nm and an irradiance of 3 mW/cm2 for 30 minutes. Four patients with corneal melting due to contact lens-related infectious keratitis showed healing without any need for further interventions up to date. In two patients, CXL stabilized the melting cornea and facilitated additional surgical procedures.
  
  
  CONCLUSIONS
  By stabilizing corneal collagen fibres, CXL seems to represent an effective option to re-establish corneal integrity in the event of pending perforations. In established perforations, CXL facilitates further emergency procedures by stiffening the tissue.
authors.affiliation: Department of Ophthalmology, Cantonal Hospital Lucerne, Lucerne, Switzerland. luzia.mueller@ksl.ch
authors.forename: L
authors.initials: L
authors.lastname: Müller
authors.forename: M A
authors.initials: MA
authors.lastname: Thiel
authors.forename: A I
authors.initials: AI
authors.lastname: Kipfer-Kauer
authors.forename: C
authors.initials: C
authors.lastname: Kaufmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D003315:Cornea / Q000187:drug effects* / Q000528:radiation effects; D003432:Cross-Linking Reagents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007634:Keratitis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D012256:Riboflavin / Q000627:therapeutic use*; D016896:Treatment Outcome; D014467:Ultraviolet Therapy / Q000379:methods*; D055815:Young Adult
chemical_list: D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D012256:Riboflavin