PHOTOACTIVATED CHROMOPHORE FOR KERATITIS (PACK CXL) AS AN ADJUNCTIVE THERAPY IN INFECTIOUS KERATITIS: CASE REPORTS

To evaluate the clinical outcomes and efficacy of Photoactivated Chromophore for Keratitis  Corneal Cross Linking (PACK CXL) as an adjunctive therapy in infectious keratitis resistant to antimicrobial therapy, in the context of increasing global antibiotic resistance. In the era of rising antimicrobial resistance, infectious keratitis remains one of the leading causes of blindness worldwide. The limited efficacy of conventional antibiotic and antifungal therapies has driven the need for more inovative, non pharmacological adjunctive treatments. 

Four patients with infectious keratitis resistant to standard medical treatment were managed using PACK CXL alongside topical therapy. 

Patients demostrated significant clinical improvement following PACK CXL. Patients in the PACK-CXL group were both assessed and treated with PACK-CXL two weeks after initial microbial and fungal therapy. After PACK-CXL treatment, patients were followed up until healing was complete.

Following CXL treatment, the patients showed significant improvement in symptoms,with a reduction in inflammation and complete re-epithelialization of the cornea within 2 weeks.Visual acuity improved, there were no complications, and the infection was fully resolved by the end of the follow-up period.

In the current era of antibiotic resistance, PACK CXL emerges as safe and promising adjunctive option for refractory bacterial and fungal keratitis. Further randomized studies are warranted to determine optimal protocols and evaluate long term outcomes.