Cross-linking is another relatively new treatment option that has been applied to AK. Whilst in vitro studies by Kashiwabuchi et al. [43] and del Buey et al. [44] have shown no amoebacidal effect of riboflavin combined with UVA exposure, clinical case reports have shown a much more promising picture. Garduño-Vieyra et al. [45] administered collagen cross-linking to a patient in Mexico in place of topical medical therapies, which were not commercially available. A significant improvement was observed after 24 hours, with symptoms resolving within three months, and a 20/20 vision was obtained after five months. Khan et al. [46] have since reported three similar cases which responded equally well to cross-linking, with all ulcers closing within seven weeks. In subsequent PK surgery for scarring, no organisms were detected in excised tissue. It is possible that the collagen stabilising effect prevents further tissue damage [47] and isolates and prevents reproduction of the amoebae. Although individual case reports results seem promising, there are no formal clinical trials thus far to recommend incorporation into standard practice.
Cross-linking is another relatively new treatment option that has been applied to AK. Whilst in vitro studies by Kashiwabuchi et al. [43] and del Buey et al. [44] have shown no amoebacidal effect of riboflavin combined with UVA exposure, clinical case reports have shown a much more promising picture. Garduño-Vieyra et al. [45] administered collagen cross-linking to a patient in Mexico in place of topical medical therapies, which were not commercially available. A significant improvement was observed after 24 hours, with symptoms resolving within three months, and a 20/20 vision was obtained after five months. Khan et al. [46] have since reported three similar cases which responded equally well to cross-linking, with all ulcers closing within seven weeks. In subsequent PK surgery for scarring, no organisms were detected in excised tissue. It is possible that the collagen stabilising effect prevents further tissue damage [47] and isolates and prevents reproduction of the amoebae. Although individual case reports results seem promising, there are no formal clinical trials thus far to recommend incorporation into standard practice.
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