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Treatment of acanthamoeba keratitis using collagen cross-linking: preliminary results from a tertiary referral center

Poster Details

First Author: H.Movahedan IRAN

Co Author(s):    M. Ashraf   A. Sadeghi Sarvestani   H. Movahedan              

Abstract Details


To evaluate the efficacy of corneal collagen cross-linking (CXL; riboflavin/ultraviolet A) as an adjunctive therapy for acanthamoeba keratitis.


Poostchi Ophthalmology Resaerch Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.


This prospective interventional case series, involved 8 patients with acanthamoeba keratitis due to contact lens use. Clinical diagnosis was followed by confocal microscopy and later confirmed by smear, culture. Patients were divided into early (<1 week from referral to presentation; n=3) and late (≥1 week; n=5) presentation groups. Upon diagnosis, all patients underwent epithelial debridement, superficial keratectomy, and conventional CXL; in addition to topical polyhexamethylene biguanide and moxifloxacin. Patients with late presentation were treated with an additional CXL followed by oral fluconazole.


In all patients with early presentation, total epithelial healing and resolution of subepithelial infiltration occurred in less than 2 weeks. No patient developed recurrence of disease up to 3 months after intervention. In all patients with late presentation, total epithelial healing and resolution of stromal infiltration associated with corneal scarring and vascularization were noted within 6-8 weeks after first CXL. No recurrence of acanthamoeba keratitis occurred up to 6 months after treatment. Two patients developed advanced corneal scarring and eventually underwent optical penetrating keratoplasty without any recurrence of infection up to 2 years after graft.


This preliminary study suggests that use of CXL as an adjunctive treatment for acanthamoeba keratitis may enhance corneal sterilization and healing, decrease the risk of recurrence, and hence, reduce need for long-term medical management. Further investigation by controlled trials are necessary to approve efficacy and reveal possible hazards of this mode of adjunctive treatment for acanthamoeba keratitis.

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