Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Middle East Afr J Ophthalmol. 2021 Jan 19;27(4):204-209. doi: 10.4103/meajo.MEAJO_130_19. eCollection 2020 Oct-Dec.
To evaluate the effectiveness of ultraviolet (UV)-A/Riboflavin corneal cross-linking (CXL) for the treatment of the refractory cases of fungal keratitis.
In this prospective interventional study, 9 patients with the diagnosis of fungal keratitis that were referred to our emergency eye center were included. These patients were resistant to conventional treatment and underwent therapeutic UV-A/Riboflavin CXL. Response to the treatment was considered as good if rapid epithelialization and rapid decrease in stromal infiltration was occurred after PACK-CXL, and poor when the emergency transplantation was necessary to eradicate the infection.
Nine patients treated with CXL due to recalcitrant fungal keratitis. Culture of the corneal scrapings showed species in 4 patients, Candida albicans in 1 patient and species in the remainder of them. CXL was performed from 1 to 20 days after the presentation of corneal ulcers (Mean: 9.12 ± 4.02; range: 5-20 days). Postoperatively, the mean time to epithelialization was 14.25 ± 2.38 days, and mean time to resolution of stromal infiltration was 22.5 ± 7.29 days, in responsive cases. Four out of 9 eyes showed good response, and five patients showed no response, and corneal transplantation was performed to eradicate the infection. There was no statistically significant difference in mean depth of infiltration and mean size of ulcer between responsive and unresponsive patients ( = 0.86 and 0.08, respectively).
Although UV-A/Riboflavin CXL is not a definite treatment for all of the fungal keratitis, it seems promising in the management of some refractory cases.
评估紫外线（UV）-A/核黄素角膜交联（CXL）治疗真菌性角膜炎难治病例的疗效。
在这项前瞻性干预研究中，纳入了 9 名被转诊至我们急诊眼科中心的真菌性角膜炎诊断患者。这些患者对常规治疗有抗药性，并接受了治疗性 UV-A/核黄素 CXL。如果 PACK-CXL 后快速上皮化和基质浸润迅速减少，则认为治疗反应良好，如果需要紧急移植以消除感染，则认为治疗反应不佳。
9 名因难治性真菌性角膜炎接受 CXL 治疗的患者。角膜刮片培养显示 4 例患者为 种，1 例患者为白色念珠菌，其余患者为 种。CXL 在角膜溃疡出现后 1 至 20 天进行（平均值：9.12 ± 4.02；范围：5-20 天）。术后，有反应的病例中平均上皮化时间为 14.25 ± 2.38 天，基质浸润消退的平均时间为 22.5 ± 7.29 天。9 只眼中有 4 只表现出良好的反应，5 只患者无反应，行角膜移植以消除感染。反应良好和无反应的患者的平均浸润深度和溃疡平均大小之间无统计学差异（=0.86 和 0.08）。
尽管 UV-A/核黄素 CXL 不是所有真菌性角膜炎的确定治疗方法，但它在某些难治性病例的治疗中似乎很有前途。
