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The therapeutic effect of accelerated photoactivated chromophore corneal cross-linking (PACK-CXL) compared to the standard antibiotic therapy in infectious keratitis

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Session Details

Session Title: Infections

Session Date/Time: Sunday 23/09/2018 | 16:30-18:00

Paper Time: 17:18

Venue: Room A3, Podium 3

First Author: : B.Knyazer ISRAEL

Co Author(s): :    Y. Krakauer   M. Abu Tailakh   T. Lifshitz   F. Hafezi           

Abstract Details


To evaluate the therapeutic effect of PACK-CXL on therapy-resistant infectious keratitis (IK) and to compare it to the effect of standard topical antibiotic therapy.


The study was conducted by the Soroka University Medical Center at the Ben-Gurion University of the Negev (Beer-Sheva, Israel) and the Center for Applied Biotechnology and Molecular Medicine at the University of Zurich (Zurich, Switzerland).


Retrospective interventional comparative study. We studied 70 eyes of 70 patients who were treated in our university ophthalmology department with IK. Patients were either treated using our standard antimicrobial protocol, or received an additional accelerated PACK-CXL (hypo-osmolaric 0.1% riboflavin solution and UV-A (365nm) irradiance of 30 mW/cm2 for 3 minutes) treatment. The size of the epithelial defect, period until healing, corrected and uncorrected visual acuity were recorded on admission and during the follow- up.


40 eyes with therapy-resistant IK were treated with PACK-CXL/antimicrobial therapy and 30 eyes with IK with standard antimicrobial therapy (control). The mean infiltrate sizes were similar (3.2±1.3mm in the PACK-CXL group and 3.1±1.13mm in the control group). Therapeutic keratoplasty was performed in 6 (18.8%) patients of the control group and no keratoplasties (0.0%) in the PACK-CXL group (P<0.001). The mean time to re-epithelialization was 7.0±1.5 days in the PACK group and 12.0 ± 2.6 days (P< 0.002) The short follow up period has been found in PACK group 2.6 months vs 4.4 months (P<0.001)


This is the first study where has been found a beneficial effect of accelerated PACK-CXL as an additional treatment modality for therapy-resistant IK. The PACK-CXL treatment may halt the infectious process and accelerate healing intra-corneal process and may help avoiding emergency keratoplasty. Further research is needed to better understand the beneficial effect of this new treatment for infective keratitis.

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