title: Corneal collagen cross-linking for infectious keratitis: an update of clinical studies.
abstract: Collagen cross-linking (CXL) with ultraviolet light-activated riboflavin is a corneal surface procedure developed for the treatment of keratoconus and corneal ectasia. With the known microbicidal and corneal stiffening effects of ultraviolet irradiation and photoactivated riboflavin, it has recently been introduced for the management of infectious keratitis, especially for ulcers resistant to antimicrobial therapy or associated with corneal melting. Various authors have attempted to use CXL as an adjunctive, salvage or even as the sole treatment for infectious corneal ulcers. The aim of this review was to provide a summary of the clinical studies in the literature. It is worth noting that there is still no consensus on the treatment protocol of CXL against infectious keratitis. The disparities in outcome measures, treatment protocol and study design can confound the interpretation and hamper the generalization of the study results. Based on current evidence, the role of CXL in infectious keratitis remained unclear despite the reported success in some clinical cases. Further investigations are warranted concerning the efficacy and safety of treating infectious keratitis with CXL.
authors.affiliation: Hong Kong Eye Hospital, Hong Kong SAR, China.|Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: Tommy C Y
authors.initials: TC
authors.lastname: Chan
authors.affiliation: Hong Kong Eye Hospital, Hong Kong SAR, China.|Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: Tiffany W S
authors.initials: TW
authors.lastname: Lau
authors.affiliation: Department of Ophthalmology, The University of Hong Kong, Hong Kong SAR, China.
authors.forename: Jacky W Y
authors.identifier: http://orcid.org/0000-0001-6249-3304
authors.initials: JW
authors.lastname: Lee
authors.affiliation: Department of Ophthalmology, The University of Hong Kong, Hong Kong SAR, China.
authors.forename: Ian Y H
authors.initials: IY
authors.lastname: Wong
authors.affiliation: Hong Kong Eye Hospital, Hong Kong SAR, China.|Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: Vishal
authors.initials: V
authors.lastname: Jhanji
authors.affiliation: Hong Kong Eye Hospital, Hong Kong SAR, China.|Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.|Department of Ophthalmology, The University of Hong Kong, Hong Kong SAR, China.
authors.forename: Raymond L M
authors.initials: RL
authors.lastname: Wong
mesh_terms: D001419:Bacteria / Q000302:isolation & purification; D003094:Collagen / Q000378:metabolism*; D003319:Corneal Stroma / Q000378:metabolism*; D003320:Corneal Ulcer / Q000188:drug therapy* / Q000378:metabolism / Q000382:microbiology; D003432:Cross-Linking Reagents; D015818:Eye Infections, Bacterial / Q000188:drug therapy* / Q000378:metabolism / Q000382:microbiology; D006801:Humans; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use; D012256:Riboflavin / Q000627:therapeutic use; D014466:Ultraviolet Rays
chemical_list: D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin
keywords: collagen cross-linking; corneal melting; infectious keratitis; photodynamic therapy; riboflavin; ulcer