1. CXL for Infectious Keratitis David Zadok, Yaakov Goldich, Isaac Avni Department of Ophthalmology Assaf Harofeh Medical Center Israel The authors have no conflicts of interest and no financial interest in the article’s subject matter or methods mentioned.

2. The combined application of riboflavin and UV inactivates pathogens –UV light alone has been shown to cause changes in the nucleic acids of pathogens so they cannot replicate (oxygen radicals). –Exposure to UV light activates the riboflavin in the complex and causes a chemical alteration to functional groups of the nucleic acids (primarily guanine bases), making pathogens unable to replicate

3. Case 1 21-year-old female Soft, color contact lenses, otherwise healthy RE: few weeks painful red eye, decreased vision, photophobia, treated with dexamethasone and chloramphenicol Signs: bulbar injection, nonsuppurative ring infiltrate, perineuritis

4. Clinical presentation: m/p Acanthamoeba keratitis Samples were taken from the conjunctiva, cornea, and contact lens containers and fluids – negative Rx: PHMB,(Chlorhexidine), Brolene CXL – TCL, ofloxacin, dexamethasone Case 1

5. Within a few days after the CXL treatment, the pain decreased, gradual reepithelization Two months after the treatment, the cornea was completely healed and the patient had no pain

6. Case 2 66-year-old female BE s/p PKP +Phaco+PC IOL (RE-2009 LE-2006) Dx: LE corneal abscess Laboratory workup – negative Rx: cefamezine + garamycin – worst vancomycin + ceftazidime - worst CXL- TCL, dexamethasone, chloramphenicol Within a few days after the CXL treatment the abscess healed

7. Case 3 42-year-old male BE s/p PKP (Keratoconus) (RE-2009, LE-2007), RGP CL Dx: LE corneal abscess Eye culture- Serratia marcescens Rx: moxifloxacin – worst, cefamezine + garamycin - worst, vancomycin + ceftazidime - worst

8. Case 3 CXL – TCL, dexamethasone, garamycin, cefamezine Corneal melting – doxycyline LE PKP – replacing melted corneal button

9. Case 3

10. Summery UVA-riboflavin crosslinking can be useful for the treatment of corneal abscesses unresponsive to medical treatment

11. Thank You