Successfully Combining Riboflavin/Uv-A And Rose Bengal/Green Light Pack-Cross-Linking In Acanthamoeba Keratitis
Published 2023 - 41st Congress of the ESCRS
Reference: PO0652 | Type: Free paper | DOI: 10.82333/xw81-yz72
Authors: Farhad Hafezi* 1 , Jürg Messerli 2 , Emilio A. Torres-Netto 3 , Nanji Lu 3 , Enes Aydemir 3 , Nikki L. Hafezi 3 , Mark Hillen 3
1Ophthalmology,ELZA Institute,Dietikon,Switzerland;Ocular Cell Biology Laboratory,University of Zurich,Zurich,Switzerland, 2Ophthalmology,University Hospital Basel,Basel,Switzerland, 3Ophthalmology,ELZA Institute AG,Dietikon,Switzerland
Purpose
PACK-Crosslinking (CXL) with Riboflavin (RB)/UV-A is in clinical use for infectious keratitis of bacterial and fungal origin. More recently, PACK-CXL with Rose Bengal (RB)/Green Light showed promise in fungal keratitis. However, neither approach was effective in treating acanthamoeba keratitis (AK). Here, we successfully treated a patient suffering from confirmed acanthamoeba keratitis using a combined approach, irradiating with both RB/UV-A and RB/Green Light in the same procedure.
Setting
ELZA Institute, Dietikon, Switzerland
Methods
A 44-year-old patient had been referred to us with active acanthamoeba keratitis in his left cornea after extended contact lens wear. Acanthamoeba cysts had been identified from fluid from the contact lens container via PCR and in the corneal stroma using confocal microscopy. Prior to the referral, the patient had been treated unsuccessfully for 10 months according to the AAO guidelines. Upon presentation, the patient presented with intense ocular pain, excessive epiphora, photophobia, and blepharospasm of the left eye. CDVA was 20/200. The conjunctiva showed diffuse hyperemia and the cornea presented with diffuse full-thickness infiltrates in the absence of a ring infiltrate. The remainder of the slit lamp exam was normal.
Results
Following the initial combined PACK-CXL treatment (June 14, 2021), the cornea showed less, but persistent signs of inflammation and infection. We re-performed the combined procedure twice (July 15 and October 4, 2021). Each PACK-CXL treatment comprised sequential RB/UV-A (365 nm) irradiation with 10 J/cm2 (C-eye and Ribo-Ker, EMAGine, Switzerland) and RB/Green Light (522 nm) irradiation (Custom-built device, 0.1% rose Bengal) with 5.4 J/cm2 in a single setting. In April 2022, the patient showed a conversion to a quiescent scar. His previous symptoms of ocular pain, photophobia, epiphora, and blepharospasm had vanished. Confocal microscopy was unable to detect acanthamoeba cysts. Currently, the patient is awaiting penetrating keratoplasty.
Conclusions
The combination of subsequent Riboflavin/UV-A and Rose Bengal/Green Light PACK-CXL successfully treated a patient suffering from confirmed AK, which was resistant to conventional medical treatment prior to our treatment attempt. PACK-Cross-Linking using two chromophores in the same procedure (riboflavin and rose Bengal) might be a future treatment alternative for acanthamoeba keratitis.