The pulsed corneal cross-linking protocol induced a significantly deeper stromal demarcation line when compared to the 4 minutes of highly accelerated continuous CXL protocol. Neither CXL protocol induced a shallower demarcation line comparable to less accelerated CXL protocols previously reported.

Purpose: To compare topical cyclosporine-A 2% eye drop (Cs-A) with prednisolone acetate 1% eye drop for treatment of herpetic stromal keratitis (HSK). Methods: In this randomized clinical trial, 38 eyes of 33 patients with HSK were randomly assigned to receive either 2% Cs-A or 1% prednisolone acetate eye drops. All subjects received oral acyclovir 400 mg twice a day. Slit-lamp examination, Scheimpflug tomography corneal optical densitometry (Pentacamâ, Oculus Inc., Wetzlar, Germany), best-corrected visual acuity (BCVA), and intra-ocular pressure (IOP) were evaluated at the first visit, and 14 and 30 days after the treatment. Results: Within-group analysis revealed significant improvement of total cornea optical density after 30 days of treatment in both groups (30.3 AE 10.5 to 28.3 AE 9.8, p < 0.001 for prednisolone group, and 30.5 AE 8.8 to 28.8 AE 8.3 p < 0.001 for Cs-A group, mean AE SD). We were not able to disclose any significant difference between the two groups regarding the improvement of cornea optical density (p = 0.66). Best-corrected visual acuity (BCVA) logMAR significantly improved in both groups after 30 days of treatment (0.20 AE 0.52, p = 0.002 in prednisolone group, and 0.24 AE 0.31, p < 0.001 in Cs-A group, mean AE SD). Analysis between groups did not show a significant difference of BCVA improvement (p = 0.45). We did not observe any severe side effect attributable to drugs. Conclusions: Cs-A 2% and prednisolone acetate 1% topical eye drops are effective for treatment of HSK.