Efficacy of photoactivated chromophore for keratitis–corneal collagen cross linking (PACK-CXL) on advanced infectious keratitis
First Author: S.Murra Antón MEXICO
Co Author(s): E. Hernández Quintela V. Sánchez Huerta G. de Witt-Carter A. Benatti
To investigate the efficacy of chromophore for infectious keratitis corneal collagen cross-linking (PACK)–CXL in the management of advanced infectious keratitis.
Asociación para Evitar la Ceguera en México
A longitudinal prospective clinical trial without control group in forty-two eyes from 41 patients with advanced infectious keratitis and concomitant corneal ulcer was performed. Eyes underwent (PACK)-CXL treatment with Dresden modified protocol in addition to regular antimicrobial therapy. The main outcomes were size of the corneal ulceration, healing, need of surgery and complications. Friedman´s test was used for statistical analysis, p values less than 0.05 were considered statistically significant.
A total of 42 eyes of 41 patients were included. The mean visual acuity was 1.87 logMAR ± 0.09 (range, 1.70 to 2.00, Snellen equivalent ~20/1480). The culture was negative in 9 eyes (21.4%) but reported gram-positive bacteria in 19 eyes (45.2%), gram-negative bacteria in 6 eyes (14.3%) and fungus in 8 eyes (19.0%). A total of 44 bacteria and fungus were identified in a total of 33 cultures; 25 were pure cultures and 9 were mixed. Four eyes needed surgery, 2 underwent tectonic corneal transplant, 1 underwent a conjunctival flap, 1 was eviscerated.
PACK-CXL might be an effective adjuvant therapy of severe infectious keratitis with a high rate of success. The procedure shows better outcomes in bacterial etiology compared to fungal keratitis. Further research is required and randomized controlled trials comparing cases of similar severity caused by the same group of pathogens are needed.