Evaluation of corneal cross-linking as adjuvant therapy for the management of fungal keratitis

  • Wei Anji 
  • Wang Kaidi 
  • Wang Yan 
  • Gong Lan 
  • Xu Jianjiang 
  • Shao Tingting Email author



To evaluate the efficacy of corneal cross-linking (CXL) as adjuvant therapy for the treatment of fungal ulcerative keratitis.


Forty-one patients with fungal ulcerative keratitis were recruited and assigned into two randomized controlled groups. These groups were treated with CXL combined with antifungal medications (CXL-M) or antifungal medications alone (M). The ulcers were assessed by slit-lamp biomicroscopy, slit-lamp images, in vivo confocal microscopy (IVCM), and anterior segment optical coherence tomography (AS-OCT). The patients were followed up before surgery/first visit (FV), 1 day after surgery, 1 and 2 weeks, and 1, 2, 3, 4, 5, and 6 months after surgery/FV.


In the cured patients, the area of corneal ulcers, the duration of ulcer healing, the time to non-observed fungal hyphae by IVCM, the number of antifungal medications, the frequency of administered medications, and the maximum ulcer depth decreased significantly after CXL (all P < 0.05) compared with the M group. There were no significant differences in either corneal thickness or epithelial thickness of ulcers after healing between 5 and 6 months after surgery in the CXL-M group, while these were increased significantly at 6 months compared with 5 months after FV in the M group (both P < 0.05).


In our study, CXL accelerated healing of the fungal ulcers, shortened the treatment duration, and minimized the need for medications and surgery. It appears that CXL is an effective procedure and adjuvant therapy for managing fungal keratitis.


Corneal cross-linking Fungal keratitis Riboflavin Ultraviolet A (UV-A) 



This work was supported by grants from the National Natural Science Foundation of China (No. 81300759).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Wei Anji 
    • 1
  • Wang Kaidi 
    • 1
  • Wang Yan 
    • 1
  • Gong Lan 
    • 1
  • Xu Jianjiang 
    • 1
  • Shao Tingting 
    • 1
    Email author
  1. 1.Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital, School of Shanghai MedicineFudan UniversityShanghaiChina

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