Long Term Follow-Up Of Using Cross Linking In Treatment Of Resistant Corneal Abscess (7 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

corneal ectesia 2 eyes 

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.

total corneal ectesia which is a late complication that developed after the corneal abscess in cases with sever corneal melting was healed need anterior segment reconstructuion