The Role Of Cross Linking In Treatment Of Resistant Corneal Abscess. (Five Year Study)

To asses  the results( clinical, microbiological and therapeutical) of using cross linking in resistant corneal abscess

The Memorial Institute for Ophthalmic Research (MIOR)

 Prospective interventional study of (40) eyes of 40 pts  with unilateral corneal abscess .Pts were done by 1 surgeon  with Fu ranges from 6 m -1years.Inclusion Criteria : pts with unilateral corneal abscess, resistant to medical TTT ,any causative organism .Excluison Criteria : corneal abscess respond to medical treatment .Surgical Technique :   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

 Pre-Op :full examination spiecally size and depth of abscess and infilteration, level of hypopyon.

post-op:  signs of improvement as corneal vascularization, decrease the infilteration and size of abscess , decrease level of hypopyon .

95%  of eyes (38 eyes)  treated with cross linking showed marked improvement within few days  ( cornea started of be vascularized, less pain, hypopyon disappear, eye became more quite).

 Those 38 eyes showed different types of infection. (Bacterial ,Fungal and Acanthamoeba keratitis)  

 Only 2 eyes showed resistant to cross linking ( fungal keratitis) and I repeated cross linking for these 2 eyes after 1 week.

 1 of them improved after 2nd cross linking session and the other showed also resistance to cross linking and  need keratoplasty .This eye was re-infected again within 1 week with aggressive course. I treated this eye after reinfection with cross linking again :

            This time showed marked improvement with crosslinking

• The use of crosslinking in resistant corneal abscess gives marvelous results and it is easy and safe
• whatever the organism, we can use cross linking in resistant corneal abscess
• In cases in which cross linking failed, we can repeat cross linking again .
• Also, In cases in which cross linking failed, we still have the chance to do tectonic keratoplasty.