The Role of Adjuvant Corneal Cross-linking in the Management of Infectious Keratitis: An OCT-Based Assessment Study

Infectious keratitis can lead to significant ocular morbidity and threaten vision if not treated promptly with antimicrobial therapy. Adjuvant treatment with corneal cross-linking (CXL) can improve visual outcomes in cases of infectious keratitis. Anterior segment optical coherence tomography (AS-OCT) can provide additional qualitative and quantitative information on healing.

This was a prospective, comparative control study of 40 eyes of 40 patients with infectious keratitis. The effectiveness of a customised epi-off CXL protocol was evaluated as adjuvant therapy. Clinical and AS-OCT parameters on days 7 and 14 of treatment, date of first report of healing and 1 month following reported healing were recorded.

Forty patients were randomly allocated to group A (medical treatment) and group B (medical treatment and CXL). The mean healing duration in days was 27.3 ± 9.27 in group A and 30.75 ± 7.39 in group B. The AS-OCT parameters corneal thickness (CT), infiltrate thickness (IT) and infiltrate width (IW) showed significant reduction compared to preoperative state with no clinically significant change between the groups (p > 0.05). The scar thickness (SC) was measured following reported complete healing and showed a statistically significant difference between the two groups (p < 0.03).

The addition of CXL to the treatment of infectious keratitis is associated with reduced scar thickness in the healing phase. Clinically, CXL as an adjuvant therapy to the medical treatment for infectious keratitis did not improve the healing duration or the final visual outcome.

NCT06967376 on ClinicalTrials.gov retrospectively registered on 13 May 2025.