To evaluate the efficacy of corneal collagen cross-linking in the treatment of corneal ulcers not responding to antimicrobial therapy.

Eight patients with corneal ulcer associated with corneal melting, not responding to conventional antibiotic therapy, were treated with collagen cross-linking. It was performed according to the standardized protocol for keratoconus. Preoperative medications were continued after surgery in all cases. Microbiological exams revealed Pseudomonas aeruginosa in 3 cases. Follow up continued from 1 to10 months.

In all but 1 eye, progression of corneal melting was halted and complete epithelialization occurred. In one eye emergency keratoplasty was needed due to corneal perforation. Furthermore, conjunctival flap was performed to treat severe localized corneal thinning in one of the patients a few days after collagen cross-linking. Significant clinical improvement occurred in all cases of Pseudomonas aeruginosa keratitis.

collagen cross-linking could be considered as a promising new treatment in the management of refractory non healing corneal ulcers, including Pseudomonas aeruginosa keratitis.