title: Ultraviolet A and riboflavin therapy as an adjunct in corneal ulcer refractory to medical treatment.
abstract: OBJECTIVE
  To present a case of corneal ulcer unresponsive to medical treatment, successfully treated with the use of ultraviolet (UV) A and riboflavin collagen crosslinking (CXL) administered twice.
  
  
  METHODS
  A 68-year-old diabetic male patient was diagnosed with unilateral severe corneal ulcer. Gram and Giemsa stains and corneal culture results were performed twice, but no specific pathogen could be detected. The clinical presentation suggested fungal infection. The ulcer was unresponsive to extensive medical treatment administered for 10 days. There was an initial response to topical and intrastromal voriconazole administration; however, this was followed by reactivation. Therefore, UVA-riboflavin treatment was performed when the patient was still on medical therapy.
  
  
  RESULTS
  The stromal infiltrate appeared inactive 1 week after UVA-riboflavin CXL treatment. However, reactivation was noticed on the second week, and a second UVA-riboflavin treatment was planned and performed 3 weeks after the first one. The epithelial defect disappeared, and the stromal infiltrate stayed inactive starting from the first week of the second UVA-riboflavin treatment until the last follow-up examination at month 6.
  
  
  CONCLUSIONS
  The UVA-riboflavin CXL may be considered in the management of corneal ulcers unresponsive to medical management.
authors.affiliation: Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey.
authors.forename: Ayhan
authors.initials: A
authors.lastname: Sağlk
authors.forename: Omür O
authors.initials: OO
authors.lastname: Uçakhan
authors.forename: Ayfer
authors.initials: A
authors.lastname: Kanpolat
mesh_terms: D000368:Aged; D003320:Corneal Ulcer / Q000188:drug therapy*; D003432:Cross-Linking Reagents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D010778:Photochemotherapy / Q000379:methods*; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D012256:Riboflavin / Q000627:therapeutic use*; D016896:Treatment Outcome; D014467:Ultraviolet Therapy / Q000379:methods
chemical_list: D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D012256:Riboflavin