Evaluation Of Accelerated Corneal Collagen Cross Linking As An Adjuvant To Standard Therapy In Moderate To Severe Fungal Keratitis : A Randomized Controlled Trial

To evaluate the role of accelerated corneal collagen cross linking (aCXL) as an adjuvant therapy in moderate to severe fungal keratitis. 

Randomized controlled clinical trial.

40 patients with unilateral fungal keratitis confirmed with in vivo confocal microscopy or KOH smears were recruited after written informed consent. Patients were prescribed standard antifungals and randomized to receive aCXL (20) or serve as controls(20). Parameters assessed baseline and post intervention (1D, 1W, 2W and 1, 3 and 6 months) included nature and intensity of symptoms, BCVA, size of ulcer, infiltrate, epithelial defect, depth of corneal involvement and hypopyon. Primary outcome measures were time taken for size and percentage reduction in epithelial defect and infiltrate at each follow up. Secondary outcome measures were BCVA, time taken for complete resolution of ulcer, change in intensity of symptoms and requirement for TPK.

Mean age (52 Y,45 Y), sex (M: 12,15), causative risk factor and associated systemic comorbidities were comparable in both groups. Size of ulcer, infiltrate, epithelial defect, depth of corneal involvement and hypopyon were comparable in both groups at baseline and subsequent follow up visits. Patients in aCXL group reported a greater reduction in intensity of symptoms (P value-0.001). 

Apart from enhancing symptomatic relief, aCXL has neither added benefit nor any adverse effect as an adjuavnt to standard antifungals in moderate to severe fungal keratitis.