title: Corneal cross-linking in the treatment of corneal ulcers.
abstract: OBJECTIVE
  New treatments for corneal ulcers are needed to address challenges with antibiotic resistance, cost, and specificity requiring timely pathogen identification. This review assesses the evidence regarding safety and efficacy of corneal cross-linking (CXL) as an adjunct or stand-alone treatment.
  
  
  RESULTS
  To date approximately 200 clinical cases of CXL used with various types of infectious keratitis have been reported in about 30 publications. Most employed the CXL protocol developed for keratoconus as an adjunct to antibiotics for resistant ulcers, and a number of cases resolved after this intervention. However, a few studies raised concerns about resurgence and perforation when CXL was utilized with deep fungal infections. The infiltrate depth is an important consideration, because the standard CXL treatment is cytotoxic (to keratocytes) to a depth of approximately 200-300 μm and 50% of the energy is absorbed within the first 100 μm. CXL was used successfully as a monotherapy in approximately 16 eyes with early bacterial or shallow fungal infections.
  
  
  CONCLUSIONS
  Further work is needed to develop optimized CXL protocols for treatment of corneal ulcers, define the appropriate conditions for use, and determine the safety and efficacy relative to standard antibiotic treatments.
authors.affiliation: aCornea Research Foundation of America bPrice Vision Group, Indianapolis, Indiana, USA.
authors.forename: Marianne O
authors.initials: MO
authors.lastname: Price
authors.forename: Francis W
authors.initials: FW
authors.lastname: Price
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003320:Corneal Ulcer / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D007634:Keratitis / Q000150:complications; D007640:Keratoconus / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents