Patients with a large central corneal ulcer and poor corrected distance visual acuity (CDVA) often turn first to medical treatment—but some ulcers remain resistant to such an approach. Now with the FDA approval of corneal collagen crosslinking, they have a new avenue to avoid penetrating keratoplasty.

Researchers recently studied 18 eyes with infectious keratitis resistant to conventional therapy that underwent photoactivated chromophore for keratitis CXL (PACK-CXL) and found positive results. Although CDVA did not improve statistically at follow-up, the procedure, which involves application of ultraviolet-A for 10 minutes for an irradiance of 9mW/cm², helped all but one eye avoid surgery.

“This low rate might be attributed to a good response to CXL,” the study concluded.