Comparison of corneal collagen cross‐linking (PACK‐CXL) and voriconazole treatments in experimental fungal keratitis

Purpose To compare the antifungal efficacy of corneal collagen cross‐linking with photoactivated riboflavin (PACK‐CXL) and voriconazole in experimental Fusarium solani and Candida albicans keratitis models. Methods Sixty‐four corneas of 32 New Zealand rabbits were included and divided into two main groups. Intrastromal injection of Fusarium and Candida suspensions was performed, and it was observed that keratitis was formed on the third day. Both groups were randomly separated into the following four groups: control, PACK‐CXL, voriconazole and PACK‐CXL combined with voriconazole. PACK‐CXL was applied using 0.25% riboflavin in an accelerated Dresden protocol (total ultraviolet A dose 5.4 J/cm²). Voriconazole was applied topically as 7x1/day with a dose of 1% (10 mg/ml). Corneal buttons were excised on the tenth day, and microbiological and pathological examinations were performed. Results The PACK‐CXL and PACK‐CXL combined with voriconazole groups each had 100 colony‐forming unit (CFU/ml) of reproduced micro‐organisms compared with 500 CFU/ml in the voriconazole group and 1500 CFU/ml in the control group (p