Table 2

Studies of corneal collagen cross-linking for management of microbial keratitis

Author, yearNoStudy designControl groupOrganismsAim of treatmentResults and comments
Iseli,34 20085Retrospective case seriesNoneMycobacteria and fungiLimiting corneal melting in healing phaseConcurrent antimicrobials used in all cases. Aim achieved in all cases.
Micelli Ferrari,35 20091Case reportNoneBacteriumPromotion of corneal healing in healing phaseConcurrent antibiotics used in all cases. Healed cornea at 1 month.
Makdoumi,38 20107Retrospective case seriesNoneBacteria and culture-negative casesCorneal sterilisation and limiting corneal melting in initial phaseConcurrent antibiotics used in six cases, one case had concurrent AMT. Complete epithelialisation achieved in all cases.
Makdoumi,42 201216Prospective studyNoneBacteria and culture-negative casesCorneal sterilisationConcurrent antibiotics used in two cases. Corneal epithelial healing achieved in all cases.
Price,43 201240Prospective studyNoneMixed organisms and culture-negative casesCorneal sterilisationConcurrent antimicrobials used in all cases. Six cases required penetrating keratoplasty. Two cases required intrastromal antifungal injections.
Li,41 20138Retrospective case seriesNoneFungiCorneal sterilisation in cases not responsive to topical antifungalsConcurrent antifungals used in all cases. Corneal epithelialisation achieved in all cases.
Mattila,40 20137Retrospective case seriesNoneBacteriaCorneal sterilisation and promotion of corneal healingConcurrent antibiotics and AM used in all cases. Corneal epithelialisation achieved in all cases.
Skaat,39 20146Retrospective case seriesNoneMixed organisms and culture-negative casesCorneal sterilisationConcurrent antimicrobials used in all cases. Five patients healed, one patient required penetrating keratoplasty.
Said,45 201440Randomised clinical trialYesMixed organisms and culture-negative casesLimiting corneal melting in healing phaseAntibiotics and cross-linking (cases) vs antibiotics only (controls). No difference in healing time or final visual acuity in the two groups. Three cases of perforation in control group vs none in cases.
Vajpayee,44 201541Retrospective case–control studyYesFungiCorneal sterilisationAntifungals and cross-linking (cases) vs antifungals only (controls).
No difference in healing time or final visual acuity in the two groups.
Bamdad,46 201532Randomised clinical trialYesBacteriaCorneal sterilisationCross-linking, then antibacterials (cases) vs antibacterials only (controls).
Cases had significantly shorter treatment duration and more rapid corneal healing than controls.
  • AM, amniotic membrane; AMT, amniotic membrane transplantation.