To report the use of accelerated photoactivated chromophore for keratitis-corneal collagen cross-linking (PACK-CXL) as a first-line treatment in a patient with an atypical fungal keratitis. Case report and literature review. A patient who presented with a painful peripheral corneal infiltrate underwent PACK-CXL with a local limited abrasion and accelerated ultraviolet-A irradiation at 365 μm and 9 mW/cm² for 10 minutes. Cultures grew Aureobasidium pullulans. The corneal epithelium closed completely within 3 days and the infiltrate was completely eradicated without administration of antibiotics. Accelerated PACK-CXL was successfully used as a first-line and sole treatment in a case of early fungal keratitis caused by Aureobasidium pullulans. Further characterization of the antifungal effect of PACK-CXL is needed in prospective studies.
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