title: Corneal cross linking and infectious keratitis: a systematic review with a meta-analysis of reported cases.
abstract: BACKGROUND
  Collagen cross linking (CXL) of the cornea has been developed recently as a new treatment for multidrug-resistant infectious keratitis. The aim of this study is to summarize the previously published data and evaluate the effectiveness of this treatment.
  
  
  RESULTS
  The search identified 12 articles. The number of eyes was 104. The infectious keratitis was associated with bacteria in 58 eyes (57f%): Gram-positive bacteria in 44 (43%; 4 of which were infected with Mycobacterium (3.6%)) and Gram-negative bacteria in 14 eyes (13%), fungus in 13 eyes (12%), and Acanthamoeba in 7 eyes (7%). In 26 eyes (25%), the microbiological culture was negative or not performed. The mean time of re-epithelization after CXL was 20.7±28.1 days (minimum of 3, maximum of 145). Sixteen eyes underwent deep or lamellar keratoplasty. The pooled analysis suggested that CXL has a favorable effect on the block of corneal melting in 85% (95%; CI 0.77, 0.91) of eyes.
  
  
  CONCLUSIONS
  Although randomized controlled trials are needed, the available evidence supports the use of CXL in the treatment of infectious keratitis.
authors.affiliation: Vissum Corporación Oftalmológica, Alicante 03016, Spain. jlalio@vissum.com.
authors.forename: Jorge L
authors.initials: JL
authors.lastname: Alio
authors.forename: Alessandro
authors.initials: A
authors.lastname: Abbouda
authors.forename: David Diaz
authors.initials: DD
authors.lastname: Valle
authors.forename: Jose M Benitez
authors.initials: JM
authors.lastname: Del Castillo
authors.forename: Jose A Gegundez
authors.initials: JA
authors.lastname: Fernandez