Corneal collagen cross-linking combined with lamellar keratoplasty in the treatment of Acanthamoeba keratitis.

PURPOSE: To compare the outcomes of corneal collagen cross-linking combined with lamellar keratoplasty (CXL-LK) versus LK alone in treating medically unresponsive acanthamoeba keratitis (AK).

METHODS

This retrospective, non-randomized controlled clinical study included 11 eyes (CXL-LK group) and 16 eyes (LK group) at a tertiary ophthalmology center. Corneal infiltration, density of acanthamoeba cysts (AC) and pathological changes following CXL in AK patients were assessed. One-year post-operation, refractive outcomes, graft survival, corneal endothelial loss rates and AK recurrence were evaluated.

RESULTS

The area and depth of the infiltrates were reduced following CXL in AK patients, and the density of the AC decreased. Histopathological results indicated a reduction in AC volume after CXL, with the contents appearing wrinkled and degraded. At one year postoperatively, the corneal endothelial loss rate was 10.12% in the CXL-LK group, significantly lower than the 27.43% observed in the LK group (p = 0.031). None of the patients in the CXL-LK group experienced AK recurrence, with an average duration of anti-amoebic treatment of 62.20 ± 50.33 days, while a significant higher proportion of patients (31.25%) in the LK group experienced recurrence, with a significantly longer treatment duration of 182.75 ± 106.77 days (p = 0.009). The graft survival rate demonstrated statistically significant differences between the two groups one year after surgery (90.9% in the CXL-LK group vs. 68.75% in the LK group, P < 0.05).

CONCLUSION

CXL reduced AK infiltration, promoted AC degradation and effectively halted disease progression. CXL-LK significantly shortened the duration of anti-amoebic treatment, decreased AK recurrence and improved graft outcomes after LK.

TRIAL REGISTRATION: ChiCTR1900026147 (2019-09-23).