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Updated: Mar 22, 2026
Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis
Published on: November 12, 2015
Cross-linking for microbial keratitis
Tommy C Y Chan1, Tushar Agarwal, Rasik B Vajpayee
1aDepartment of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong bHong Kong Eye Hospital, Mongkok, Kowloon, Hong Kong SAR, China cDr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India dVision Eye Institute, Royal Victorian Eye and Ear Hospital, North West Academic Centre eCentre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia.
Purpose Of Review:
Microbial keratitis is one of the leading causes of ocular morbidity. The standard treatment consists of antibiotics, which is intensive and is fraught with risks of antibiotic resistance. Corneal collagen cross-linking (CXL) has recently been advocated as an adjunctive therapy for management of microbial keratitis. The addition of CXL to ongoing antimicrobial treatment can have a potential effect on overall duration of the disease, need for corneal transplantation, final visual outcome, and long-term impact on drug resistance pattern.
Recent Findings:
CXL has been used in cases with bacterial, fungal as well as amoebic keratitis. However, so far the reported results have been variable and the evidence is largely anecdotal. The debate over the safety and efficacy of this modality continues especially with regards to its utilization in early phases of the disease when the corneal involvement is limited to the anterior stroma.
Summary:
CXL appears to be a promising adjunctive treatment in selective cases of mild to moderate bacterial keratitis. Its efficacy in fungal and amoebic keratitis is questionable. Treatment protocols in microbial keratitis need to be individualized. Long-term, prospective, randomized trials are needed to determine its usefulness in microbial keratitis.
Insights
Corneal collagen cross-linking (CXL) shows promise as an add-on treatment for mild to moderate bacterial keratitis. Its effectiveness in fungal and amoebic keratitis requires further investigation, with individualized treatment plans being essential.
Area of Science:
- Ophthalmology
- Microbiology
- Biotechnology
Background:
- Microbial keratitis is a significant cause of vision loss.
- Standard antibiotic treatment faces challenges including resistance and intensive regimens.
- Corneal collagen cross-linking (CXL) is emerging as a potential adjunctive therapy.
Purpose of the Study:
- To review the role of CXL as an adjunctive therapy for microbial keratitis.
- To evaluate the impact of CXL on disease duration, transplantation rates, visual outcomes, and antibiotic resistance.
- To assess the current evidence for CXL in bacterial, fungal, and amoebic keratitis.
Main Methods:
- Review of existing literature on CXL in microbial keratitis.
- Analysis of reported outcomes in bacterial, fungal, and amoebic keratitis cases.
- Discussion of safety and efficacy debates, particularly in early-stage disease.
Main Results:
- CXL has been applied to bacterial, fungal, and amoebic keratitis with variable results.
- Evidence supporting CXL's efficacy is largely anecdotal.
- Safety and efficacy, especially in early disease stages, remain under debate.
Conclusions:
- CXL shows potential as an adjunctive treatment for select mild to moderate bacterial keratitis cases.
- Efficacy in fungal and amoebic keratitis is uncertain.
- Individualized treatment protocols are necessary, and further randomized trials are needed.
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