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Corneal collagen cross-linking (CXL) has been investigated not only for ectatic disease but also as an adjunct in infectious keratitis, where ultraviolet exposure and photoactivated riboflavin may have antimicrobial and tissue-stabilizing effects. A systematic review and meta-analysis identified multiple clinical studies involving bacterial, fungal, Acanthamoeba, and viral keratitis. Across the available literature, reported healing rates were encouraging, but the authors emphasized substantial heterogeneity and a lack of sufficiently robust randomized evidence. The key clinical point is that CXL should not be interpreted as a replacement for appropriate antimicrobial therapy or source control. Instead, it has been studied as an adjunct in selected ulcers, particularly those with progression or stromal melt. Patient selection and organism type matter, and evidence is much less supportive for viral disease. For cornea specialists, the topic is important because it sits at the intersection of infection control, biomechanics, and tissue preservation. Any use outside established protocols should be framed around the limitations of current evidence and the need for close microbiological and clinical monitoring.
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Corneal collagen cross-linking (CXL) has been investigated not only for ectatic disease but also as an adjunct in infectious keratitis, where ultraviolet exposure and photoactivated riboflavin may have antimicrobial and tissue-stabilizing effects. A systematic review and meta-analysis identified multiple clinical studies involving bacterial, fungal, Acanthamoeba, and viral keratitis. Across the available literature, reported healing rates were encouraging, but the authors emphasized substantial heterogeneity and a lack of sufficiently robust randomized evidence. The key clinical point is that CXL should not be interpreted as a replacement for appropriate antimicrobial therapy or source control. Instead, it has been studied as an adjunct in selected ulcers, particularly those with progression or stromal melt. Patient selection and organism type matter, and evidence is much less supportive for viral disease. For cornea specialists, the topic is important because it sits at the intersection of infection control, biomechanics, and tissue preservation. Any use outside established protocols should be framed around the limitations of current evidence and the need for close microbiological and clinical monitoring.
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