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

Ayhan Sağlk, M.D.; Ömür Ö. Uçakhan, M.D.; Ayfer Kanpolat, M.D.


Eye Contact Lens. 2013;39(6):413-415. 

In This Article

Abstract and Introduction


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.


Riboflavin and ultraviolet (UV) A collagen crosslinking (CXL) of the cornea was first introduced by Wollensak et al.[1] in 2003 for the treatment of keratoconus. This method has a stiffening effect on the corneal stroma, which increases its biomechanical strength, thus enabling the arrest of the progression of the disease.

Recent clinical and in vitro studies have suggested that UVA-riboflavin CXL may be effective in the treatment of corneal ulcers.[2–8] A number of publications have described successful treatment of therapy-resistant infectious ulcers and the arrest of corneal melting with UVA-activated riboflavin.[2,4–6]

We present herein a case of presumed infectious corneal ulcer unresponsive to medical treatment, which was effectively treated with two successive adjuvant UVA-riboflavin CXL therapies.