Antimicrobial Efficacy of Riboflavin/UVA Combination (365 nm) In Vitro for Bacterial and Fungal Isolates: A Potential New Treatment for Infectious Keratitis

Martins, Suy Anne Rebouças; Combs, Juan Castro; Noguera, Guillermo; Camacho, Walter; Wittmann, P.; Walther, R.; Cano, Marisol; Dick, James D.; Behrens, Ashley

doi:10.1167/iovs.07-1592

Cited by 221 publications

(224 citation statements)

References 53 publications

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“…This effect was greater for gram-positive bacteria compared with Pseudomonas aeruginosa. In this study, riboflavin alone had no effect as an antibacterial agent (26) . In another in vitro study, a dose of 10.8J/cm 2 , corresponding to 60 minutes of UVA irradiation, led to higher rates of eradication of every organism included in the study.…”

Section: Discussioncontrasting

confidence: 52%

“…Such enzymes are released at the injury site by bacteria and inflammatory cells (2) . In addition to its antibacterial effect, CXL makes the corneal stroma more resistant to the effects of enzymes such as pepsin, trypsin, and collagenase (26) . Studies show that CXL significantly changes corneal elasticity, produces a 328% increase in rigidity, and increases resistance to proteolytic enzymes.…”

Section: Discussionmentioning

confidence: 99%

“…Studies show that CXL significantly changes corneal elasticity, produces a 328% increase in rigidity, and increases resistance to proteolytic enzymes. Thus, it increases resistance against microbial degradation and corneal melting (26,(35)(36) . Even though some clinical trials and experimental studies have shown improvement of fungal ulcers with CXL (21,23) , this was not observed in our study.…”

Section: Discussionmentioning

confidence: 99%

“…There are reports of corneal ulcers treated successfully with corneal collagen crosslinking (CXL) (18)(19)(20)(21)(22)(23)(24)(25) . An experimental study found increased resistance to enzymatic digestion by collagenase, pepsin, and trypsin in corneas subjected to CXL (26) . Ultraviolet A light (UVA) associated with riboflavin acts as photomediator, causing riboflavin molecules to lose their internal balance and creating oxygen free radicals that induce new links between collagen fibrils.…”

mentioning

confidence: 99%

“…Currently, CXL is usually indicated for cases of keratoconus (30) , pellucid marginal degeneration (31) , painful bullous keratopathy (32) , and iatrogenic ectasia after refractive surgery with laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) (30) . The therapeutic effects of CXL in infectious keratitis are still unclear (18)(19)(20)(21)(22)(23)(24)(25)(26) . This study aimed to evaluate the effect of CXL on infectious keratitis resistant to medical treatment.…”

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confidence: 99%

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Efeito terapêutico do crosslinking corneal na ceratite infecciosa

Escarião¹,

Ribeiro²,

Jorge³

et al. 2013

Rev. bras.oftalmol.

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Purpose:To evaluate the effect of corneal crosslinking (CXL) RESUMOObjetivo: Avaliar o efeito do crosslinking (CXL) no tratamento de ceratite infecciosa, resistente ao tratamento clínico, e investigar a relação com o agente etiológico. Métodos: Foram incluídos 11 pacientes com diagnóstico de ceratite infecciosa de etiologia bacteriana (sete olhos) e fúngica (quatro olhos) na Fundação Altino Ventura (FAV) no período de outubro de 2011 a maio de 2012. Os pacientes incluídos estavam em uso de colírios há pelo menos sete dias e não apresentavam melhora da infecção. Estes foram avaliados antes da realização do CXL e no período pós-operatório até cicatrização da úlcera. Para realização do CXL foram instiladas gotas de riboflavina a 0,1% e dextrano a 20%, a cada cinco minutos em um período de 30 minutos antes do procedimento, e durante a aplicação da luz ultravioleta A (UVA). A córnea foi exposta à UVA com comprimento de onda de 370ηm ± 5ηm e uma irradiância de 3mW/cm². Resultados: Os pacientes com infecção bacteriana obtiveram cura do processo infeccioso após o CXL e nenhum paciente com ceratite fúngica apresentou cicatrização. Observou-se associação significante (p = 0,003) entre o agente etiológico e a cicatrização. Conclusão: O CXL mostrou-se eficaz no tratamento da ceratite bacteriana resistente ao tratamento clínico, evitando a realização de transplante tectônico. Em relação à ceratite fúngica, este procedimento não influenciou na melhora do processo infeccioso.Descritores: Córnea; Reagentes para ligações cruzadas/uso terapêutico; Ceratite infecciosa/quimioterapia; Ceratite bacteriana/ quimioterapia; Ceratite fúngica/quimioterapia

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Section: Discussioncontrasting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Efeito terapêutico do crosslinking corneal na ceratite infecciosa

Escarião¹,

Ribeiro²,

Jorge³

et al. 2013

Rev. bras.oftalmol.

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Keratoconus and Other Corneal Diseases: Pharmacologic Cross-Linking and Future Therapy

Hsu

Sugar

2016

Handbook of Experimental Pharmacology

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The ability to cross-link collagen fibers and use this technique to strengthen the cornea has become of great interest to ophthalmologists in the last decade. For progressive diseases such as keratoconus, collagen cross-linking confers the possibility of halting progression and stabilizing the cornea, a benefit that is not observed with any other current treatment. Collagen cross-linking uses riboflavin combined with ultraviolet A light to induce the formation of bonds between collagen fibrils that strengthen the cornea. This chapter will discuss the theory, technique, indications, and complications of corneal cross-linking. Much of what will be discussed is in areas of active research that will likely be further clarified as more experience is gained with this procedure.

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