Evaluation of corneal collagen cross-linking as an additional therapy in mycotic keratitis

Background To report the treatment outcomes of mycotic keratitis with collagen cross‐linking. Design Retrospective study. Participants Patients with smear‐positive moderate mycotic keratitis. Methods A retrospective case‐file analysis was performed to identify cases of moderate mycotic keratitis treated with and without additional collagen cross‐linking, in addition to intensive topical antifungal therapy. Patients in which collagen cross‐linking was performed on the day of presentation (group 1) were compared with patients who received medical treatment alone in the form of 5% natamycin eye drops (group 2). Main Outcome Measures The primary outcome measure was the time taken for resolution of infection. Results Overall, 41 cases were included for analysis (group 1, 20 cases; group 2, 21 cases). Mean age of the patients was comparable in both groups (46.5 ± 17.01 vs. 41.2 ± 20.7 years; P = 0.36). Average infiltrate size was 16.35 ± 6.8 mm2 in group 1 and 17.09 ± 7.4 mm2 in group 2 (P = 0.83). Overall, Aspergillus was the most commonly isolated organism (n = 4 group 1; n = 6 group 2). Resolution of infection was observed in 18 cases (90%) in group 1 and 18 (85.71%) cases in group 2. The average healing time was 30.85 ± 26.6 days in group 1, while it was 31.28 ± 19.97 days in group 2 (P = 0.94). Final best‐corrected visual acuity in group 1 was 1.13 ± 0.55 and 1.25 ± 0.46 in group 2 (P = 0.46). A tectonic keratoplasty was performed in two cases in group 1 and three cases in group 2 (P = 1.00). Conclusions In our study, additional collagen cross‐linking treatment did not have any advantage over medical management in cases with moderate mycotic keratitis.