Green Light-Activated Rose Bengal Cross-Linking in 81 Horses With Complex Corneal Ulcers and Stromal Abscesses

To assess the efficacy and safety of Rose Bengal and green light corneal cross-linking (RGX) as an adjunctive treatment for complicated corneal ulcers and stromal abscesses in horses.

A retrospective analysis included 81 horses (82 eyes) treated with RGX between 2018 and 2024. Cases involved complicated corneal diseases such as melting keratitis, fungal keratitis, deep stromal defects, and stromal abscesses. Treatment consisted of topical or iontophoretic administration of 1% Rose Bengal followed by green light irradiation (550 nm; 150 J/cm²) for 10 min. Most procedures (76.8%) were carried out under standing sedation. RGX was combined with adjunctive surgical procedures in 74 eyes (90.2%). Clinical evolution, epithelialization time, and complications were recorded.

Ocular comfort markedly improved within 1 week in all horses. Keratomalacia resolved within 24 h post-RGX in 80% of affected eyes. Fluorescein-negative corneal epithelialization was achieved in 86.6% of cases during hospitalization, with a mean healing time of 18.6 ± 7.3 days. Complications were observed in 9.7% of eyes, predominantly associated with fungal keratitis. Rescue therapies, including repeat RGX and/or surgical procedures, were successful in all but one case, which ultimately required enucleation. The overall success rate, defined as globe preservation and ulcer resolution, was 98.8%.

RGX represents a safe and effective adjunctive treatment modality for complicated corneal ulcers and stromal abscesses in horses. The procedure is well tolerated, can be performed under standing sedation, and may significantly reduce the frequency and intensity of postoperative topical therapy.