Accelerated High Fluence Photoactivated Chromophore For Infectious Keratitis—Corneal Cross-Linking (Pack-Cxl) At The Slit Lamp: A Pilot Study
Published 2024 - 42nd Congress of the ESCRS
Reference: FP11.11 | Type: Free paper | DOI: 10.82333/dzhr-cf10
Authors: Boris Knyazer* 1 , Asaf Achiron 2 , Farhad Hafezi 3
1Ophthalmology,Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva,Israel, 2Ophthalmology, Sourasky Medical Center , Tel Aviv University,Tel Aviv,Israel, 3ELZA Institute,Zurich,Switzerland;University of Zurich,Ocular Cell Biology Group, Center for Applied Biotechnology and Molecular Medicine,Zurich,Switzerland
Purpose
Photoactivated Chromophore for Infectious Keratitis-Corneal Cross-Linking (PACK-CXL) has garnered substantial interest among researchers and ophthalmologists due to its high promise as a potential treatment for infectious keratitis. The aim of this study is to evaluate the efficacy and safety of high-fluence PACK-CXL using 10.0 J/cm2 (30 mW/cm2, 5 min, and 33 s) at the slit lamp.
Setting
Patients were admitted to the emergency room of the Department of Ophthalmology at Soroka University Medical Center, Beer-Sheva, Israel (SUMC), between March 2021 and February 2022. The study was approved by the Institutional Review Board (IRB) of the Ben-Gurion University of the Negev, Israel
Methods
This prospective interventional, nonrandomized cohort study included 20 eyes of 20 patients with bacterial, fungal, or mixed origin keratitis who underwent high fluence PACK-CXL treatment as an adjunct therapy to conventional antimicrobial therapy per American Academy of Ophthalmology treatment guidelines. The re-epithelization time was recorded, and corneal endothelial cell density was counted before and after treatment.
Results
The average re-epithelization time was 8.2 ± 2.8 days (range 3-14 days). After PACK-CXL treatment, eight patients (40%) were directly discharged, while the remained patients stayed in the hospital for an average of 5.6 ± 3.5 days. No eyes required keratoplasty. Endothelial cell density counts before and after the PACK-CXL procedure were 2,562.1 ± 397.3, and 2,564.8 ± 404.5 cells/mm2, respectively (p = 0.96).
Conclusions
Although it was not a randomized control trial, we conclude that high-fluence PACK-CXL as an adjuvant therapy is safe with no complications observed and efficient, as the time to re-epithelization was less than 14 days for all patients and no patients underwent tectonic keratoplasties. Further research is needed to compare it to the current standard of care.