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The following is a summary of “Corneal cross-linking for infectious keratitis of various causes: an umbrella review,” published in the April 2025 issue of BMC Ophthalmology by Farhadi et al. 

Researchers conducted a retrospective study to analyze the therapeutic potential of corneal cross-linking (CXL) in treating infectious keratitis.  

They performed an umbrella review of systematic reviews and meta-analyses on CXL for infectious keratitis. Keywords were chosen based on the PICO framework (Population: People who have CXL for infectious keratitis; Intervention: corneal cross-linking; Comparison: other treatments such as antibiotic therapy; Outcome: Primary outcome was considered as the efficacy of treatment using re-epithelization and heal rate, and secondary outcome was considered need to penetrating keratoplasty (PK) and searched Cochrane, PubMed, MEDLINE, Embase, SCOPUS, CINAHL, Psychoinfo, and ProQuest until August 2024.  

The results showed that 5 systematic reviews were included from 53 identified records. Statistical analysis could not be performed due to the study structure; 4 studies focused on adjuvant CXL in bacterial keratitis and 1 on fungal keratitis. Results were heterogeneous: 2 reviews found a short corneal epithelium healing with adjuvant CXL compared to standard antibiotic therapy (SAT), especially in fungal keratitis, while 2 studies showed no difference, 1 meta-analysis reported a smaller corneal infiltrate size 7 days post-adjuvant CXL compared to SAT. No differences in corneal complications, such as perforation or the need for PK, were observed between CXL and SAT groups.  

Investigators concluded that CXL for infectious keratitis lacked a uniform protocol, particularly regarding the de-epithelization process, leading to heterogeneous trial results; however, adjuvant CXL alongside SAT appeared not inferior to SAT alone and may offer superior outcomes in some cases, including fungal infections, by promoting faster corneal healing. 

Source: bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-025-04038-3