THE USE OF CROSS LINKING VERSUS THE USE OF KERATOPLASTY IN TREATMENT OF RESISTANT CORNEAL ABSCESS. (FIVE YEAR STUDY)

To compare the results of using keratoplasty versus using  cross linking in resistant corneal abscess 

The Memorial Institute For Ophthalmic Research

Prospective interventional comparative study of (80) eyes of 80 patients ( 40 in each group) (65 males and 15 female) aged between 15-60 years with unilateral corneal abscess .Patients were done by 1 surgeon in the memorial institute for ophthalmic research (MIOR) with follow up period ranges from 6 m -1years.Inclusion Criteria : patients with unilateral corneal abscess, resistant to medical treatment ,any causative organism .Exclusion Criteria : corneal abscess respond to medical treatment .Surgical Technique :  tectonic keratoplasty was done as original PKP with some precautions as to take all the abscess in the trephined area leaving edges free of infection , wash the anterior segment with antibiotics, use interrupted sutures . and in cross linking , 1st scrap the cornea to remove the residual epithelium and dead tissue then soaking the cornea for 20 min. then use ultraviolet (Avedro) in the pulsed mode for 6 mins  . Preoperative: full ophthalmic examination specially size and depth of abscess and infiltration, level of hypopyon, ultrasound to assess posterior segment involvement  .post-operative:  signs of improvement as corneal vascularization, decrease the infiltration and size of abscess , decrease level of hypopyon .

95% of eyes treated with cross linking showed marked improvement within few days , only 2 eye  showed resistant to cross linking and need keratoplasty . while only 67.5% of eyes treated with tectonic keratoplasty improved and 32.5% ( 13 eyes) showed reinfection within 2 week and some times with more aggressive course ,  these 13  eyes were treated after reinfection with cross linking ,12 of them respond to crosslinking and only 1 need regrafting again .

Using keratoplasty or cross linking give good results to treat resistant corneal abscess but there is high incidence of reinfection (failure) with keratoplasty than with crosslinking which  shows excellent results.

So, the use of crosslinking in resistant corneal abscess is more easy and more safe technique and give better results than keratoplasty and also the don’t loss the chance to do tectonic keratoplasty if cross linking failed