title: Evaluation of corneal collagen cross-linking as an additional therapy in mycotic keratitis.
abstract: BACKGROUND
  To report the treatment outcomes of mycotic keratitis with collagen cross-linking.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Patients with smear-positive moderate mycotic keratitis.
  
  
  METHODS
  A retrospective case-file analysis was performed to identify cases of moderate mycotic keratitis treated with and without additional collagen cross-linking, in addition to intensive topical antifungal therapy. Patients in which collagen cross-linking was performed on the day of presentation (group 1) were compared with patients who received medical treatment alone in the form of 5% natamycin eye drops (group 2).
  
  
  METHODS
  The primary outcome measure was the time taken for resolution of infection.
  
  
  RESULTS
  Overall, 41 cases were included for analysis (group 1, 20 cases; group 2, 21 cases). Mean age of the patients was comparable in both groups (46.5 ± 17.01 vs. 41.2 ± 20.7 years; P = 0.36). Average infiltrate size was 16.35 ± 6.8 mm(2) in group 1 and 17.09 ± 7.4 mm(2) in group 2 (P = 0.83). Overall, Aspergillus was the most commonly isolated organism (n = 4 group 1; n = 6 group 2). Resolution of infection was observed in 18 cases (90%) in group 1 and 18 (85.71%) cases in group 2. The average healing time was 30.85 ± 26.6 days in group 1, while it was 31.28 ± 19.97 days in group 2 (P = 0.94). Final best-corrected visual acuity in group 1 was 1.13 ± 0.55 and 1.25 ± 0.46 in group 2 (P = 0.46). A tectonic keratoplasty was performed in two cases in group 1 and three cases in group 2 (P = 1.00).
  
  
  CONCLUSIONS
  In our study, additional collagen cross-linking treatment did not have any advantage over medical management in cases with moderate mycotic keratitis.
authors: Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Orissa, India; Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia.
authors: Rasik B
authors: RB
authors: Vajpayee
authors: Shah N
authors: SN
authors: Shafi
authors: Prafulla K
authors: PK
authors: Maharana
authors: Namrata
authors: N
authors: Sharma
authors: Vishal
authors: V
authors: Jhanji
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000008:administration & dosage; D002648:Child; D003094:Collagen / Q000378:metabolism*; D003131:Combined Modality Therapy; D003319:Corneal Stroma / Q000378:metabolism*; D003320:Corneal Ulcer / Q000188:drug therapy* / Q000378:metabolism / Q000382:microbiology; D003432:Cross-Linking Reagents; D015821:Eye Infections, Fungal / Q000188:drug therapy* / Q000378:metabolism / Q000382:microbiology; D005260:Female; D005658:Fungi / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy* / Q000378:metabolism / Q000382:microbiology; D010866:Natamycin / Q000008:administration & dosage; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D012189:Retrospective Studies; D012256:Riboflavin / Q000627:therapeutic use; D014792:Visual Acuity / Q000502:physiology
chemical_list: D000935:Antifungal Agents; D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D010866:Natamycin; D003094:Collagen; D012256:Riboflavin
keywords: collagen cross-linking; fungal keratitis; mycotic keratitis; outcomes; treatment