International Journal of Keratoconus and Ectatic Corneal Diseases

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VOLUME 5 , ISSUE 1 ( January-April, 2016 ) > List of Articles


Corneal Collagen Cross-linking in Infective Keratitis

Shiji Ummar

Citation Information : Ummar S. Corneal Collagen Cross-linking in Infective Keratitis. Int J Kerat Ect Cor Dis 2016; 5 (1):13-16.

DOI: 10.5005/jp-journals-10025-1115

Published Online: 01-06-2011

Copyright Statement:  Copyright © 2016; The Author(s).


Purpose of review

To summarize the current understanding of effects of cross-linking (CXL) in infective keratitis based on available evidence.

Method of literature search

A PubMed search was conducted with combinations not limited to the following search terms: corneal collagen CXL, riboflavin, ultraviolet A, keratoconus, microbial keratitis, fungal keratitis, bacterial keratitis, Acantha-moeba keratitis. A review of the search results was performed and relevant articles to the topic were included.


Most of the published literature showed promising results in treatment of infectious keratitis by corneal collagen CXL using photoactivated riboflavin as an adjuvant therapy but with questionable efficacy in deep keratitis due to slow-growing organisms.

How to cite this article

Ummar S, Farrag AN. Corneal Collagen Cross-linking in Infective Keratitis. Int J Kerat Ect Cor Dis 2016;5(1):13-16.

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  1. Riboflavin/ultraviolet-A induced collagen crosslinking for the treatment of keratoconus. Am J Ophthalmol 2003 May;135(5):620-627.
  2. The use of riboflavin for the inactivation of pathogens in blood products. Vox Sang 2000;78(Suppl 2):S211-S215.
  3. Current status of corneal collagen cross-linking for keratoconus: a review. Clin Exp Optom 2013 Mar;96(2):155-164.
  4. Increased rigidity of the cornea caused by intrastromal crosslinking. Ophthalmologe 1997 Dec;94(12):902-906.
  5. Stress-strain measurements of human and porcine corneas after riboflavin ultraviolet- A-induced cross-linking. J Cataract Refract Surg 2003 Sep;29(9):1780-1785.
  6. Induction of cross-links in corneal tissue. Exp Eye Res 1998 Jan;66(1):97-103.
  7. Collagen cross-linking: a new treatment paradigm in corneal disease – a review. Clin Exp Ophthalmol 2010 Mar;38(2):141-153.
  8. Mechanisms of corneal tissue cross-linking in response to treatment with topical riboflavin and long-wavelength ultraviolet radiation (UVA). Invest Ophthalmol Vis Sci 2010 Jan;51(1):129-138.
  9. Increased resistance of crosslinked cornea against enzymatic digestion. Curr Eye Res 2004 Jul;29(1):35-40.
  10. Microbial keratitis predisposing factors and morbidity. Ophthalmology 2006 Jan;113(1):109-116.
  11. Decision-making in the management of microbial keratitis. Ophthalmology 1981 Aug;88(8):814-820.
  12. The crisis in antibiotic resistance. Science 1992 Aug 21;257(5073):1064-1073.
  13. Impact of antibiotic resistance in the management of ocular infections: the role of current and future antibiotics. Clin Ophthalmol 2009;3:507-521.
  14. Photosensitized inactivation of ribonucleic acids in the presence of riboflavin. Biochim Biophys Acta 1965 Jun 8;103(2):360-363.
  15. Photoinactivation of virus in packed red blood cell units using riboflavin and visible light. Transfusion 2000;40(Suppl):99S.
  16. Irradiation of cornea with ultra- violet light and riboflavin administration as a new treatment for erosive corneal processes, preliminary results in four patients. Klin Monbl Augenheilkd 2000 Sep;217(3):190-193.
  17. Ultraviolet A/riboflavin corneal cross-linking for infectious keratitis associated with corneal melts. Cornea 2008 Jun;27(5):590-594.
  18. PACK-CXL: defining CXL for infectious keratitis. J Refract Surg 2014 Jul;30(7):438-439.
  19. Photo-activated riboflavin therapy of refractory corneal ulcers. Cornea 2012 Oct;31(10):1210-1213.
  20. Combined treatment with flap amputation, phototherapeutic keratectomy, and collagen crosslinking in severe intractable post- LASIK atypical mycobacterial infection with corneal melt. J Cataract Refract Surg 2012 Apr;38(4):713-715.
  21. Riboflavin- UVA treatment in the management of edema and nonhealing ulcers of the cornea. J Refract Surg 2009 Sep;25(9):S803-S806.
  22. Riboflavin and ultraviolet a collagen crosslinking of the cornea for the treatment of keratitis. Cornea 2010 Jan;29(1):102-104.
  23. Riboflavin and ultraviolet light A therapy as an adjuvant treatment for medically refractive acanthamoeba keratitis. Ophthalmology 2011 Feb;118(2):324-331.
  24. Ultraviolet-a light and riboflavin therapy for acanthamoeba keratitis: a case report. Case Rep Ophthalmol 2011 May;2(2):291-295.
  25. Photoactivated riboflavin treatment of infectious keratitis using collagen cross-linking technology. J Refract Surg 2012 Oct;28(10):706-713.
  26. Impending corneal perforation after collagen cross-linking for herpetic keratitis. J Cataract Refract Surg 2013 Apr;39(4):638-641.
  27. Riboflavin/ ultravoilet light-mediated crosslinking for fungal keratitis. Br J Ophthalmol 2013 May;97(5):669-671.
  28. Collagen cross-linking with photoactivated riboflavin (PACK-CXL) for the treatment of advanced infectious keratitis with corneal melting. Ophthalmology 2014 Jul;121(7):1377-1382.
  29. Collagen crosslinking in the management of advanced non- resolving microbial keratitis. Br J Ophthalmol 2014 Aug;98(8):1033-1035.
  30. Evaluation of corneal collagen cross-linking as an additional therapy in mycotic keratitis. Clin Exp Ophthalmol 2015 Mar;43(2):103-107.
  31. Corneal cross-linking as an adjuvant therapy in the management of recalcitrant deep stromal fungal keratitis: a randomized trial. Am J Ophthalmol 2015 Jul;160(1):131-134.
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