Comparison of Accelerated and Standard Corneal Collagen Cross-Linking Treatments in Experimental Fungal Keratitis for Aspergillus fumigatus

INTRODUCTION: To compare accelerated and standard corneal collagen cross-linking (CXL) treatments in experimental Aspergillus keratitis models. METHODS: Twenty-six New Zealand rabbits were divided into two groups: a 1% voriconazole combined with standard CXL group, and a 1% voriconazole combined with accelerated CXL group. The ulcer area, corneal opacity, and corneal neovascularization score were measured via slit-lamp imaging, and the corneal and corneal epithelial thickness and ulcer depth were measured via anterior segment optical coherence tomography (AS-OCT). The duration of the hyphae was observed via in vivo confocal microscopy (IVCM), and the cornea was taken for pathological examination after modeling and at the end of the study to determine the hyphae and corneal repair. The observation times were as follows: at successful modeling (day 0) and at 1, 4, 7, 14, 21, and 28 days after the intervention. RESULTS: The area and depth of the ulcer decreased in both groups after CXL (all P < 0.05). Interestingly, the ulcer area in the accelerated CXL group still tended to increase on the first day after CXL although the difference was not statistically significant (P=0.6649). On the 21st and 28th days after CXL, the ulcer area and depth of the standard CXL group were larger and deeper than those of the accelerated CXL group (all P < 0.05). The ulcer healing time in the accelerated CXL group was 18.67 ± 6.21 days, while that in the standard CXL group was 23.55 ± 4.72 days, and the difference was statistically significant (P=0.0475). CONCLUSIONS: Both accelerated and standard CXL can significantly inhibit the progression of Aspergillus keratitis corneal ulcers and promote ulcer healing. The accelerated CXL was superior to the standard CXL, which could control infection faster and promote ulcer healing. However, it is important to note that there may be a risk of early deterioration of the ulcer with accelerated CXL.