Is Corneal Collagen Cross-Linking Beneficial as an Adjunct to the Conventional Treatment of Bacterial Keratitis?

Amira Asem Mahmoud1, 2, Mohamed Saad Abd-Rahman1, 2, Tarek Ahmed Mohamed1, 2, Dalia Mohamed El-Sebaity1, 2, *
1 Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt
2 El-Nour Eye Centre, Assiut, Egypt

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© 2022 Mahmoud et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Ophthalmology, Assiut University Hospital, 71515 Assiut, Egypt; Tel: +201223212962; E-mails:,



To evaluate the therapeutic effects of corneal collagen cross-linking CXL as an adjuvant to standard antimicrobial agents in the treatment of bacterial keratitis when compared to treatment with antimicrobial agents alone.


This prospective comparative interventional study included 20 eyes of 20 patients with clinical and laboratory evidence of bacterial keratitis who attended the Outpatient Cornea Unit, Ophthalmology Department, Faculty of Medicine in Assiut University Hospital, Assiut, between January 2019 and December 2020.Patients were divided into two groups: group A, treated with CXL using the Dresden Protocol at the EL-Nour Eye Centre, and group B treated with antibiotics alone.


Group A had ten patients in the age range of 20-80 years (mean age 49.2 years), while that of group B (ten patients) was 19 -70 years (mean age 47.3 years).

The ulcer sizes started to decrease significantly from week 2 in group A to week 3 in group B. The epithelization time was significantly different between the two treatment groups as reepithelization in 60% of group A cases started at week two, while it began at week three in group B. There was no significant difference in the V/A between the two groups after treatment.


CXL as an adjunct to topical antimicrobial treatment was more effective in treating bacterial keratitis than conventional antimicrobial therapy alone, as it led to shorter recovery times due to more rapid ulcer healing, resolution of infiltration, and faster symptomatic relief in patients. Despite CXL promoted the ulcer to heal quickly, there was no significant change in V/A before and after CXL or between the CXL with antimicrobial or antimicrobial therapy alone .

Keywords: Cornea, Collagen cross-linking, Bacterial keratitis, Keratitis, Corneal tissue, Topical broad-spectrum antibiotics.