Corneal collagen cross-linking window absorption

PURPOSE:: To evaluate the safety and efficacy of treatment of severe infectious corneal ulcers with hypoosmolar riboflavin solution and UV-A collagen cross-linking (CXL) without deepithelizing the cornea. METHODS:: Four eyes of 3 patients with severe keratitis and associated corneal melting, were treated with a new protocol of corneal CXL for infectious keratitis, named cross-linking window absorption (CXL-WA). CXL-WA was performed when the infection did not respond to systemic and topical antibiotic therapy. The protocol entails the use of hypoosmolar riboflavin before the irradiation with UV-A, and the penetration is obtained through the epithelial defect overlying the ulcer. RESULTS:: In all cases, CXL halted the progression of the ulcer. After a minimum follow-up of 3 months, none of the patients had recurrence of the infection. CONCLUSION:: CXL-WA is a promising technique of treatment of infectious corneal ulcers, delaying or preventing more invasive approaches.