Pack Cross-Linking As Adjuvant Therapy Improves Clinical Outcomes In Culture-Confirmed Bacterial Keratitis

Published 2022 - 40th Congress of the ESCRS

Reference: FPT02.01 | Type: Free paper | DOI: 10.82333/t1sq-r212

Authors: Boris Knyazer* ¹ , Farhad Hafezi ² , Tamir Regev ³ , Yonit Krakauer ³ , Erez Tsumi ³ , Omar Elhaddad ⁴ , Asaf Achiron ⁵

¹Ophthalmology Department,Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev,Beer-Sheva,Israel, ²ELZA Institute,Dietikon,Switzerland;Faculty of Medicine,University of Geneva,Geneva,Switzerland;Center for Applied Biotechnology and Molecular Medicine (CABMM) ,University of Zurich, Zurich,Switzerland, ³Ophthalmology Department,Soroka University Medical Center,Beer-Sheva,Israel, ⁴Bristol Eye Hospital,University Hospitals Bristol NHS Foundation Trust,Bristol,United Kingdom, ⁵Ophthalmology Department,Sackler Faculty of Medicine, Tel Aviv University,Tel Aviv,Israel

Purpose

We recently showed the positive clinical effects of combining accelerated cross-linking (PACK-CXL) with antibiotic treatment in patients with presumed bacterial keratitis. In the current study, we compare the impacts of a combined PACK-CXL/standard antibiotic treatment (PACK-ABX group) to standard antibiotic treatment alone (ABX group), in patients with culture-confirmed bacterial keratitis.

Setting

This was a retrospective interventional cohort study, approved by the Institutional Review Board (IRB) of the Ben-Gurion University of the Negev, Israel, and it adhered to the Declaration of Helsinki's tenets.

Methods

We reviewed patients with moderate and severe bacterial

keratitis and confirmed bacterial cultures. Clinical outcomes were

compared for standard antibiotic treatment alone, before the

initiation of PACK-CXL, and after adjuvant use of PACK-CXL.

We reviewed patients with moderate and severe bacterialkeratitis and confirmed bacterial cultures. Clinical outcomes werecompared for standard antibiotic treatment alone, before theinitiation of PACK-CXL, and after adjuvant use of PACK-CXL.

Results

A total of 47 eyes of 47 patients were included: 26 eyes in the PACK-ABX group, and 21 eyes in the ABX group. The PACK-ABX patients had better final UDVA (mean difference 0.57 logMAR,95%CI:0.16-0.99, p=0.07) and CDVA (mean difference 0.70 logMAR, 95%CI:0.23-1.16,p=0.04), shorter re-epithelialization time (mean difference 9.63 days, 95%CI:3.14-16.12, p=0.004), and reduced number of clinic visits (mean difference 4.8 meetings, 95%CI:1.4-8.2, p=0.007) and need for tectonic grafts (0 vs 33.3%, p=0.002). A multivariate analysis controlling for age, gender, ulcer size, and gram showed that PACK-ABX treatment remained significantly associated with re-epithelialization (β=14.5, p=0.001).

Conclusions

In our study, PACK-CXLs addition to the standard of care in cases of culture-proven bacterial keratitis had a positive effect on the final visual acuity and time to resolution, compared with the standard-of-care treatment.

In our study, PACK-CXLs addition to the standardof care in cases of culture-proven bacterial keratitis had a positiveeffect on the final visual acuity and time to resolution, comparedwith the standard-of-care treatment.