Studies have demonstrated that corneal cross-linking (CXL) as adjuvant therapy can accelerate healing in fungal ulcers, shorten treatment duration and minimize the need for medications and surgery; however, a recent study published in Cornea found that this may not be the case for bacterial ulcers.1,2

The clinical trial included patients with smear-positive bacterial ulcers.2 The researchers randomized affected eyes to receive topical moxifloxacin 0.5% or topical moxifloxacin 0.5% with CXL.

The researchers found that those who received CXL had a 60% decreased odds of culture positivity at 24 hours, as well as 0.9logMAR worse visual acuity and 0.41mm larger scar size at three months. None of these results were statistically significant. They observed fewer cornea perforations or need for therapeutic photorefractive keratectomy in the CXL group.

Ultimately, they were unable to confirm any benefit of adjuvant CXL as a primary treatment for moderate bacterial keratitis. They wrote, however, that “CXL may reduce culture positivity and complication rates; therefore, a larger trial to fully evaluate this is warranted.”

1. Wei A, Wang K, Wang Y, et al. Evaluation of corneal cross-linking as adjuvant therapy for the management of fungal keratitis. Graefes Arch Clin Exp Ophthalmol 2019;257:7:1443-52.

2. Prajna NV, Radhakrishnan N, Lalitha P, et al. Cross-linking assisted infection reduction (CLAIR): A randomized clinical trial evaluating the effect of adjuvant cross-linking on bacterial keratitis. Cornea. October 19, 2020. [Epub ahead of print].