Drug Depository (Reservoir) Contact Lens Reduces Antimicrobial Treatment Burden In Bacterial Keratitis: Results Of A Randomized Controlled Study

Microbial keratitis can cause unilateral blindness, but the drug delivery treatment options are poor. Therefore, this study evaluated the efficacy of a novel therapeutic drug-depository contact lens (DDCL) for bacterial keratitis (BK) treatment and its role in reducing the treatment burden. The lens was designed to increase the corneal lesion-antimicrobial drug interaction time.

Prospective, single-center, randomized, open-label, two arms, clinical study.

An open-labelled randomized controlled study to compare topical antimicrobial administration and antimicrobial administration with DDCLs for treating BK. Bacterial Keratitis (BK) patients were randomized (1:1) into two groups: topical antimicrobial treatment only, with an intensive loading dosage of hourly for the first two days and 2-hourly for the next 12 days (Group 1) and DDCL plus reduced antimicrobial treatment with 2-hourly for first two days followed by 4-hourly for next 12 days (Group 2). Both groups received 0.5 % moxifloxacin. We evaluated BK recovery, anterior chamber (AC) reactions, corneal haze, and pain (on a 10-point scale) 12 hours and 1, 3, 5, and 14 days after treatment.

The baseline corneal-infiltration (i.e., BK severity) values were comparable for Groups 1 (18 cases) and 2 (17 cases) (P = 0.92). After 12 hours, the scores improved in both groups and continued to improve throughout the follow-up period; the improvements were more pronounced in Group 2 than in Group 1 (all P <0.05). Complete recovery occurred on Days 14 and 5 in Groups 1 and 2, respectively. Furthermore, the AC reaction was resolved by Day 3 in Group 2. The baseline pain scores were also comparable between Groups 1 and 2 (P = 0.52) and decreased throughout the follow-up period (all P <0.05); the decrease was more pronounced in Group 2.

Novel DDCLs augment the drug-lesion interaction time by prolonging corneal antimicrobial availability, which hastens corneal healing in Bacterial Keratitis. Thus, a DDCL may decrease the antibiotic regimen and improve patient tolerance, eliminating the necessity for a loading dose.