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Expert practice patterns and opinions on corneal cross-linking for infectious keratitis
  1. Yen C Hsia1,
  2. Caitlin A Moe2,
  3. Thomas M Lietman1,2,
  4. Jeremy D Keenan1,2,
  5. Jennifer Rose-Nussbaumer1
  1. 1 Department of Ophthalmology, University of California, San Francisco, California, USA
  2. 2 Francis I Proctor Foundation, University of California, San Francisco, California, USA
  1. Correspondence to Dr Jennifer Rose-Nussbaumer; jennifer.rose-nussbaumer{at}


Objective To assess the current opinion and practice patterns from cornea experts regarding the benefit of corneal cross-linking (CXL) for infectious keratitis (IK).

Methods and analysis An international survey was distributed to corneal specialists via an internet survey. The survey data collected were analysed with descriptive statistics.

Results A survey was sent to 190 recipients, and 29 (15%) respondents completed the survey with an average of 7 years’ experience using CXL. A majority of respondents (66%) used CXL to treat IK due to bacterial, fungal, protozoan or unknown aetiology. Main indications to use CXL as adjuvant therapy were worsening infiltrate diameter or depth despite therapy (74%), followed by antibiotic resistance (68%), corneal thinning (53%), poor compliance with medication (26%) and other reasons (21%). Most respondents felt CXL would be at least moderately helpful as an adjuvant therapy for bacterial (96%) or fungal (75%) keratitis; about half (46%) thought it would be helpful for acanthamoeba keratitis. As sole therapy, fewer respondents believed CXL would be at least moderately helpful to treat bacterial (75%), fungal (58%) and acanthamoeba (43%) keratitis.

Conclusion The survey offered insights into current expert practices and opinions of using CXL as therapy for IK. The results of this survey serve to guide in the design of future clinical studies.

  • cornea
  • microbiology
  • infection
  • inflammation
  • treatment medical
  • wound healing

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  • Contributors JR-N contributed to study design and implementation, data analysis and writing of this manuscript. YCH and CAM contributed to data analysis and writing of the manuscript. TML and JK were involved in design and implementation of this study.

  • Funding Individual support for this study came from K23 EY025025 (JRN) and an unrestricted grant from Research to Prevent Blindness (JRN).

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval Ethical approval for this study was obtained from the University of California, San Francisco Committee on Human Research (UCSF Institutional Review Board).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement De-identified survey response data can be provided on request.

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