Ultraviolet A and Riboflavin Therapy As an Adjunct in Corneal Ulcer Refractory to Medical Treatment

Objective: To present a case of corneal ulcer unresponsive to medical treatment, successfully treated with the use of ultraviolet (UV) A and riboflavin collagen crosslinking (CXL) administered twice.

Methods: A 68-year-old diabetic male patient was diagnosed with unilateral severe corneal ulcer. Gram and Giemsa stains and corneal culture results were performed twice, but no specific pathogen could be detected. The clinical presentation suggested fungal infection. The ulcer was unresponsive to extensive medical treatment administered for 10 days. There was an initial response to topical and intrastromal voriconazole administration; however, this was followed by reactivation. Therefore, UVA-riboflavin treatment was performed when the patient was still on medical therapy.

Results: The stromal infiltrate appeared inactive 1 week after UVA-riboflavin CXL treatment. However, reactivation was noticed on the second week, and a second UVA-riboflavin treatment was planned and performed 3 weeks after the first one. The epithelial defect disappeared, and the stromal infiltrate stayed inactive starting from the first week of the second UVA-riboflavin treatment until the last follow-up examination at month 6.

Conclusion: The UVA-riboflavin CXL may be considered in the management of corneal ulcers unresponsive to medical management.