Accelerated corneal cross-linking combined with topical voriconazole versus topical amphotericin B For the treatment of fungal keratitis with corneal melting

Objective This work aims to compare the safety and efficacy of accelerated corneal cross-linking (A-CXL) combined with topical voriconazole (VCZ) versus A-CXL combined with topical amphotericin B for the treatment of fungal keratitis (FK) with corneal melting. Patients and methods This is a retrospective comparative clinical cohort study. Total 40 eyes with clinically suspected and lab-confirmed FK with corneal melting were included. These eyes were classified randomly into two groups each of 20 eyes; group (A) was treated by repeated sessions of A-CXL plus topical VCZ and group (B) was treated by repeated sessions of A-CXL combined with topical amphotericin B. The end point of this study was complete corneal healing with negative culture on lab examination. Identification of organisms was done by lab study before and after treatment. Corneal healing was evaluated by corneal examination and anterior segment optical coherence tomography. Results Visual acuities improved from a mean decimal value of 0.063–0.25 in group (A) and from 0.08 to 0.125 in group (B) at the end of the follow-up period (12 months). Group (A) showed more improvement especially after the 3rd month compared with group (B), P less than 0.05. Corneal infiltration size reduced from mean of 32.4–1.15 mm in group (A), while it was reduced from 31.2 to 12.5 mm in group (B) at the end of the follow-up period. Reduction in infiltration size in group (A) was significantly reduced more than group (B), P value less than 0.001 highly significant. The success rate of treatment in group (A) was very highly significant ( P <0.001) and in group (B) was weak significant ( P =0.045). Comparison between the two groups showed highly significant difference ( P =0.006). On the other hand, treatment failure was 0 in group (A) and eight cases in group (B) with highly significant difference ( P <0.001). Conclusion The success of A-CXL in the treatment of FK is summarized by its known effect of reversal of corneal melting and anti-infective properties. A-CXL combined with topical VCZ was found to be more effective in treating FK with corneal melting than A-CXL combined with amphotericin B with better visual outcomes.