Photoactivated Chromophore for Keratitis-CXL as First Line and Sole Treatment for Infectious Keratitis
To study whether PACK (photoactivated chromophore for keratitis)-CXL can be used as a first-line and sole treatment in bacterial and fungal infectious keratitis.
Five eyes of five patients with an infectious keratitis and a corneal infiltrate received PACK-CXL as a first-line treatment. PACK-CXL was performed as follows: 2 mm abrasion over the infiltrate, application of transepithelial 0.1% ricoflavin solution for 30 minutes, followed by 5 min of UV-A irradiation at 18 mW/cm2. Postoperative medication was Vitamin A ointment only. Patients were examined clinically every 24 hours for the first three days, and would receive antibiotic therapy if the clinical picture worsened.
Signs of infectious keratitis resolved completely in all cases at day 1 after PACK-CXL. No initiation of antimicrobial therapy became necessary in all five cases. All cases fully re-epithelialized within the first 48 hours after PACK-CXL. At 30 days after the procedure, all corneas showed completed wound healing. Pathogens identified from corneal swaps included Pseudomonas aeruginosa and Klebsiella.
PACK-CXL, when applied in early cases of infectious corneal infiltrates, may be sufficient enough to treat the infection. These findings might be of particular importance given the worldwide increasing resistance to antibiotics as well as in countries where the access to antibiotics is not readily affordable to all.