Therapeutic Effect of Corneal Crosslinking on Fungal Keratitis: Efficacy of Corneal Collagen Crosslinking as an Adjuvant Therapy for Fungal Keratitis in a Tertiary Eye Hospital in South India

ABSTRACT

Purpose

To evaluate the efficacy of CXL in treating fungal keratitis as an adjuvant therapy.

Methods

Detailed clinical examination microbiological investigation was performed. Twenty fungal keratitis patients were recruited and randomized into two groups: group 1 (n= 11, standard antifungal), group 2 (n=9, corneal collagen crosslinking with standard antifungal). Corneal scraping and tear samples collected were subjected to real-time PCR targeting ITS, TLR analysis and cytokine analysis.

Results

The mean time for complete resolution of ulcer for group 2 was significantly shorter compared to group 1 and the final mean BCVA was better for group 2. Expression of IL-1β, IL-8, IFN-γ significantly decreased immediately post CXL in group 2 patients. Significant downregulation of TLR 6, TLR-3, TLR-4 was observed 3-days post CXL compared to group 1 patients.

Conclusion

Adjuvant effect of CXL was significant in treating fungal keratitis compared to standalone antifungal treatment.

KEYWORDS:

• Fungal keratitis
• corneal collagen crosslinking
• toll – like receptors
• cytokines
• adjuvant therapy

List of Abbreviations

CXL – corneal collagen crosslinking

IL - Interleukin

TLR –Toll-like receptor

Acknowledgments

The authors would like to thank Mr Vijay, Ms Shuba, Mr Balaji of LASIK & Refractive surgery department and Dr Srujana chitipothu, Mr R. Bhuvana Sundar, Ms Lakshmi– Faculties of Core facility, Vision research foundation.

Competing Interests

The authors declare that they have no competing interests.

Consent For Publication

NA

Declaration of Interest

The authors have no financial or proprietary interest in any of the materials used in this study.

Availability of Data and Material

The data that support the findings of this study are not publicly available due to them containing information that could compromise research participant confidentiality.

Ethics Approval

The study was approved by The Institutes Review Board of Vision Research Foundation, Sankara Nethralaya, Chennai, India. Informed consent was obtained from each person before performing the related procedures.

Authors Contributions

VJ contributed to the study design, data collection and data analysis and led the drafting of the manuscript, DP data collection, and data analysis, drafting the manuscript under direction and support from JM, HNM and PP. PP, NVN, MLY contribute to study design, patient recruitment and sample collection, PSK, PPJ contributed in the collection and processing of clinical samples. All authors read and approved the final manuscript.

Additional information

Funding

The work was fully funded by Indian council of medical research (ICMR)