Modified crosslinking in the treatment of purulent keratitis and corneal ulcers

Purpose

To evaluate the efficacy of modified crosslinking (M-CXL) in the treatment of purulent corneal ulcers, including those of mixed etiology.

Methods

The M-CXL method consists of simultaneous cross-linking and frequent instillations (FI) of anti-infective solutions. We observed 36 patients (37 eyes) with purulent corneal ulcers (PCU) of various etiologies. The test group included 24 patients (24 eyes) who received 1–2 sessions of M-CXL with active conservative therapy. In the control group (12 patients, 13 eyes), only active conservative therapy was performed.

Results

Complete reduction of the purulent process was achieved in 18 (75%) eyes in 29.6 ± 9.38 days in the test group; and in 8 eyes (61.5%) in 50.4 ± 15.9 days in the control group. The efficiency of M-CXL ranged from 100% to 66.6% depending on depth and width (square area) of the infiltration in question. In cases where infiltration affected the entire stromal thickness, the M-CXL efficacy sharply decreased to 66.6%, even with its small (<6 mm) area. In cases where infiltrations extended to the Descemet’s membrane with an overall area >7 mm, the clinical effect of M-CXL was absent or insufficient.

Conclusion

In 75% cases, M-CXL showed complete reduction of PCU. Comparing with control groups, the duration of treatment in the test group decreased 42% (P less than 0.05). In infiltrations over a wide area affecting all the layers up to the Descemet’s membrane, resorbtion of the purulent focus was not achieved. However, it’s spread and purulent fusion were sufficiently suspended, thereby allowing therapeutic penetrating keratoplasty to be performed with a smaller graft diameter.