Researchers recently took a closer look at the antimicrobial and antikeratolytic properties of corneal collagen crosslinking (CXL) in the context of treating fungal keratitis, and the study results are promising.

They enrolled 53 patients with confirmed fungal keratitis and randomized them into two groups: those who underwent therapeutic keratoplasty (TPK) using CXL-treated donor corneas, and those who had TPK with non-CXL treated donor corneas. After analyzing the postoperative incidence of graft infection, graft clarity, visual acuity, deep vascularization of the graft and other complications, they found none of the CXL group developed infection compared with six in the non-CXL group.

They also found 80.8% of patients in the CXL group had clear grafts at six months post-op compared with 22.2% of the non-CXL group. As for corrected visual acuity, 50% of patients in the CXL group achieved 20/200 or better, compared with only 7.4% in the non-CXL group.

“CXL-treated donor corneas may help to reduce the incidence of graft infection after TPK in fungal keratitis, and a beneficial effect is observed in terms of visual acuity and graft clarity,” the study authors said. “Further long-term multicenter prospective randomized trials with larger sample sizes and in which optical grade donor tissues are used are required to confirm the results of our study and to elucidate the functional outcomes of TPK with CXL-treated donor corneas.”

Titiyal JS, Karunakaran A, Kaur M, et al. Collagen cross-linked therapeutic grafts in fungal keratitis. Ophthalmology. May 5, 2018. [Epub ahead of print].