Accelerated corneal collagen cross-linking in clinical management of infectious keratitis

Li, Miao; Yu, Tao; Gào, Xīn; Wu, Xinyi

doi:10.1177/0300060520926411

Cited by 6 publications

(4 citation statements)

References 33 publications

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“…Li, et al (2020) 10 showed that patients with infectious keratitis who underwent corneal collagen cross-linking (CXL) had an overall cure rate of 93.85% (94.12% in the case of fungal keratitis and 91.67% in the case of bacterial keratitis); there was no discernible difference in the cure rates between the two groups. The groups with baseline ulcer sizes 4 mm x 4 mm and those with baseline ulcer size 4mm x 4mm to 7mm x 7mm; had cure rates of 95.23% and 91.30%, respectively; there was no statistically significant difference between the two groups.…”

Section: Resultsmentioning

confidence: 99%

The Analysis Study of Management and Outcomes of Corneal Disease: A Comprehensive Systematic Review

Utomo,

Jamilah

2024

JARMHS

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Background: A group of conditions affecting the cornea are referred to as corneal disease. These diseases affect over 10 million people worldwide and are caused by various clinical diseases, such as traumatic injuries, chemical burns, infections, and iatrogenic reasons. Causes include bacterial keratitis, fungal keratitis, Herpes Simplex Keratitis (HSK), trachoma, dry eye disease, keratoconus, ophthalmia neonatorum, and non-infectious neonatorum. The causes of corneal disease affect how they are managed. The outcomes of these interventions vary. The aim: This study aims to determine the management and outcomes of corneal disease. Methods: By comparing itself to the standards set by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. So, the experts were able to make sure that the study was as up-to-date as it was possible to be. For this search approach, publications that came out between 2014 and 2024 were taken into account. Several different online reference sources, like Pubmed, SAGEPUB, and ScienceDirect, were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Results: In the PubMed database, the results of our search brought up 1358 articles, whereas the results of our search on SAGEPUB brought up 1823 articles, and our search on ScienceDirect brought up 6091 articles. In the end, we compiled 6 papers, 3 of which came from PubMed, 2 of which came from ScienceDirect, and 1 of which came from SagePub. We included six research that met the criteria. Conclusion: In conclusion, surgical management shows good outcomes in controlling the corneal diseases. It can also maintain structural integrity of cornea and contribute to lowering blindness worldwide.

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Section: Resultsmentioning

confidence: 99%

The Analysis Study of Management and Outcomes of Corneal Disease: A Comprehensive Systematic Review

Utomo,

Jamilah

2024

JARMHS

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“…Patients undergoing an accelerated (fast) PACK-CXL protocol in the present study were less likely to experience treatment failure, meaning that acceleration could be a potential “success factor”. Effectiveness of accelerated PACK-CXL was previously described in case reports of infectious keratitis in dogs and cats [ 3 , 45 ], and in human patients [ 46 , 47 ]. These reports, however, did not include comparison groups.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of risk factors for treatment failure in canine patients undergoing photoactivated chromophore for keratitis – corneal cross-linking (PACK-CXL): a retrospective study using additive bayesian network analysis

Kowalska,

Shukla,

Arteaga

et al. 2023

BMC Vet Res

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Background Infectious keratitis is a common ophthalmic condition in canine patients. Sequelae can include keratomalacia and corneal perforation, a vision threatening outcome. Photoactivated chromophore for keratitis – corneal cross-linking (PACK-CXL) is a non-surgical, adjunctive treatment method for infectious keratitis. The goal of this retrospective, multicenter study was to determine risk factors for treatment failure following PACK-CXL in canine patients suffering from suspected infectious keratitis. Medical records from four veterinary ophthalmology services were reviewed, and information related to patient demographics, ophthalmic findings, the PACK-CXL protocol used, and epithelialization time was collected and analyzed. Due to the potential for intervariable relationships, an additive Bayesian network (ABN) analysis was performed to evaluate these complex relationships. Results Records for 671 eyes (668 dogs) were included in the analysis. Based on the ABN, in the population included here, patients who underwent an accelerated PACK-CXL protocol were less likely to experience treatment failure versus patients treated with a slow protocol. Mutual dependencies between exposure variables were identified by ABN, which would have been overlooked using classical regression. Corneal re-epithelialization time was shortened following PACK-CXL combined with topical medical therapy compared to PACK-CXL alone. Conclusions No risk factors associated with treatment failure were identified in the population included in the present study. Canine patients may benefit from the use of accelerated PACK-CXL protocols, especially when combined with topical antibiotics and anti-collagenolytic therapy. The reasons for this apparent positive impact on treatment outcome remain unclear.

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“…However, the role of corneal crosslinking in the management of mycotic keratitis remains controversial in humans with different studies providing conflicting results. Some case reports [162][163][164][165] and major studies [159,166,167] have shown corneal crosslinking to be a useful adjunctive therapy for managing fungal keratitis. However, the Cross Linking Assisted Infection Reduction Trial (CLAIR trial), a randomised control trial [159] done to evaluate the role of corneal collagen crosslinking in the management of fungal keratitis concluded that it has no added advantage and furthermore suggested that crosslinking can result in inferior visual outcomes when compared with standard medical management in fungal keratitis.…”

Section: Photo Activated Chromophore For Keratitismentioning

confidence: 99%

Recent Perspectives in the Management of Fungal Keratitis

Raj

Vanathi

Ahmed

et al. 2021

JoF

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Mycotic keratitis is common in warm, humid regions with a varying profile of pathogenic fungi according to geographical origin, socioeconomic status, and climatic condition. Clinical diagnosis can be challenging in difficult cases and those refractory to treatment. Fungal hyphae on microscopic examination and culture isolation have been the gold standard in the laboratory diagnosis of fungal keratitis. A culture isolate of the aetiological fungus is essential to perform antifungal susceptibility testing. As the culture isolation of fungi is time-consuming, causing delays in the initiation of treatment, newer investigative modalities such as in vivo confocal microscopy and molecular diagnostic methods have recently gained popularity. Molecular diagnostic techniques now help to obtain a rapid diagnosis of fungal keratitis. Genomic approaches are based on detecting amplicons of ribosomal RNA genes, with internal transcribed spacers being increasingly adopted. Metagenomic deep sequencing allows for rapid and accurate diagnosis without the need to wait for the fungus to grow. This is also helpful in identifying new emerging strains of fungi causing mycotic keratitis. A custom-tear proteomic approach will probably play an important diagnostic role in future in the management of mycotic keratitis. Positive repeat cultures are being suggested as an important gauge indicative of a poor prognosis. Positive repeat fungal cultures help to modify a treatment regimen by increasing its frequency, providing the addition of another topical and oral antifungal agent along with close follow-up for perforation and identifying need for early therapeutic keratoplasty. The role of collagen crosslinking in the treatment of fungal keratitis is not convincingly established. Rapid detection by multiplex PCR and antifungal susceptibility testing of the pathogenic fungi, adopted into a routine management protocol of fungal keratitis, will help to improve treatment outcome. Early therapy is essential in minimizing damage to the corneal tissue, thereby providing a better outcome. The role of conventional therapy with polyenes, systemic and targeted therapy of antifungal agents, newer azoles and echinocandins in fungal keratitis has been widely studied in recent times. Combination therapy can be more efficacious in comparison to monotherapy. Given the diversity of fungal aetiology, the emergence of new corneal pathogenic fungi with varying drug susceptibilities, increasing the drug resistance to antifungal agents in some genera and species, it is perhaps time to adopt recent molecular methods for precise identification and incorporate antifungal susceptibility testing as a routine.

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Accelerated corneal collagen cross-linking in clinical management of infectious keratitis

Cited by 6 publications

References 33 publications

The Analysis Study of Management and Outcomes of Corneal Disease: A Comprehensive Systematic Review

The Analysis Study of Management and Outcomes of Corneal Disease: A Comprehensive Systematic Review

Evaluation of risk factors for treatment failure in canine patients undergoing photoactivated chromophore for keratitis – corneal cross-linking (PACK-CXL): a retrospective study using additive bayesian network analysis

Recent Perspectives in the Management of Fungal Keratitis

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