Collagen Cross-Linking with Photoactivated Riboflavin (PACK-CXL) for the Treatment of Advanced Infectious Keratitis with Corneal Melting

Said, Dalia G.; El‐Alfy, Mohamed; Gatzioufas, Zisis; El-Zakzouk, Ehab S.; Hassan, Mansour; Saif, Mohamed Yasser Sayed; Zaki, Ahmed; Dua, Harminder S; Hafezi, Farhad

doi:10.1016/j.ophtha.2014.01.011

Cited by 184 publications

(154 citation statements)

References 28 publications

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“…Furthermore, UV radiation itself can damage both DNA and RNA of pathogens and is used as an antimicrobial procedure 22. Recently, CXL with the interaction of riboflavin and UV irradiation was reported to also be used in corneal infections 23, 24, 25. After the topical application of riboflavin and UVA light, the reaction causes the release of very reactive singlet oxygen and other reactive oxygen radicals, which leads to apoptosis of, for example, keratocytes in the cornea 26, 27, 28.…”

Section: Introductionmentioning

confidence: 99%

UV light crosslinking regresses mature corneal blood and lymphatic vessels and promotes subsequent high-risk corneal transplant survival

Hou

Tóth

et al. 2018

American Journal of Transplantation

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Immunologic graft rejection is the main complication after corneal transplant into pathologically prevascularized so‐called high‐risk eyes. The aim of this study was to evaluate whether ultraviolet (UV) light crosslinking can regress pathologic corneal blood and lymphatic vessels and thereby improve subsequent graft survival. Using the murine model of suture‐induced corneal neovascularization, we found that corneal crosslinking with UVA light and riboflavin regressed both preexisting blood and lymphatic vessels significantly via induction of apoptosis in vascular endothelial cells. In addition, macrophages and CD45+ cell counts were significantly reduced. Consistently, corneal crosslinking reduced keratocyte density and corneal thickness without affecting corneal nonvascular endothelial cells, iris, and lens depending on the crosslinking duration. Furthermore, using the murine model of corneal transplant, long‐term graft survival was significantly promoted (P < .05) and CD4+ CD25+FoxP3+ T regulatory cells were upregulated (P < .01) in high‐risk eyes preoperatively treated with crosslinking. Our results suggest UV light crosslinking as a novel method to regress both pathologic corneal blood and lymphatic vessels and to reduce CD45+ inflammatory cells. Furthermore, this study demonstrates for the first time that preoperative corneal crosslinking in prevascularized high‐risk eyes can significantly improve subsequent graft survival and may become a promising novel therapy in the clinic.

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Section: Introductionmentioning

confidence: 99%

UV light crosslinking regresses mature corneal blood and lymphatic vessels and promotes subsequent high-risk corneal transplant survival

Hou

Tóth

et al. 2018

American Journal of Transplantation

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“…Several studies also support the utility of collagen cross-linking in the treatment of patients with advanced bacterial keratitis (Bettis et al 2012;Price et al 2012;Alio et al 2013;Vazirani and Vaddavalli 2013;Shetty et al 2014b), although the degree of efficacy has yet to be well defined. In one prospective study, cross-linking did not decrease the time to corneal healing, but did decrease corneal perforations and recurrence of infection (Said et al 2014). …”

Section: Keratitismentioning

confidence: 98%

“…As in keratoconus, patients also have high astigmatism. The use of collagen cross-linking has been reported in these patients, with inferiorly decentered irradiation to treat the area of thinning, with benefit similar to that seen in keratoconus patients (Spadea 2010;Hassan et al 2014;Moshirfar et al 2014). Animal studies suggest that the decentered irradiation involving the limbus does not affect the regenerative capacity of limbal stem cells (Richoz et al 2014).…”

Section: Pellucid Marginal Corneal Degenerationmentioning

confidence: 98%

Corticosteroids and Anti-Complement Therapy in Retinal Diseases

Narayanan

Kuppermann

2016

Handbook of Experimental Pharmacology

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“…(57) The only comparative prospective study that evaluates the use of medication alone versus medication associated to PACK-CXL was described by Said et al and revealed that the cure time was the same, with a trend for faster resolution in the PACK-CXL group. (58) A systematic review and meta-analysis of 12 case series suggests better cicatrization time in bacteria-related cases and worse prognosis and greater transplant risk in cases of fungi, acanthamoeba and gram-negative bacteria. (59) Accelerated protocols also seem able to treat and eliminate pathogenic agents, allowing for quicker treatment and with equivalent resolution regarding pathogen death.…”

Section: Photoactivated Chromophore For Keratitis -Pack-cxlmentioning

confidence: 99%

Corneal Crosslinking: The Standard Protocol

Santhiago¹

2017

Revista Brasileira De Oftalmologia

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RESUMOO objetivo desta revisão é de determinar as indicações e eficácia da cirurgia que promove novas ligações covalentes entre as fibras de colágeno da córnea, conhecida como Cross-Linking (CXL), assim como esclarecer seus objetivos. O ceratocone é uma doença ectasica da córnea, bilateral, assimétrica, que, principalmente, cursa com encurvamento e afinamentos progressivo, e se inicia em geral na segunda década de vida. O uso primário do CXL tem sido na interrupção da progressão do Ceratocone. Apesar do conhecido encurvamento no estroma da córnea ocorrer nesses pacientes, a fisiopatologia por trás do ceratocone ainda é desconhecida e parece ser multifatorial. Pela evidencia literária disponível até o momento, o CXL da córnea esta, portanto indicado nos pacientes com doença em progressão. Concluímos que existe evidencia suficiente para afirmar que o CXL da córnea é eficaz na estabilização da doença ectásica da cornea.Descritores: Córnea/fisiologia; Córnea/metabolismo; Cross-linking reagentes; Ceratocone/terapia; Riblflavina/administração & dosagem; Protocolos ABSTRACT The purpose of this review is to determine the indications and efficacy of the surgery that promotes new covalent bonds between the collagen fibers of the cornea, known as Cross-Linking (CXL), as well as to clarify its objectives. Keratoconus is a bilateral, asymmetric ectasic disease of the cornea that mainly courses with steepening and progressive thinning, and usually begins in the second decade of life.The primary use of CXL has been in discontinuing the progression of keratoconus. Although known corneal stromal remodeling occurs in these patients, the pathophysiology behind keratoconus is still unknown and appears to be multifactorial. By the literary evidence available to date, the CXL of the cornea is safely indicated in patients with progressing disease. We conclude that there is sufficient evidence to affirm that cornea CXL is effective in stabilizing corneal ectasic disease.

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Collagen Cross-Linking with Photoactivated Riboflavin (PACK-CXL) for the Treatment of Advanced Infectious Keratitis with Corneal Melting

Cited by 184 publications

References 28 publications

UV light crosslinking regresses mature corneal blood and lymphatic vessels and promotes subsequent high-risk corneal transplant survival

UV light crosslinking regresses mature corneal blood and lymphatic vessels and promotes subsequent high-risk corneal transplant survival

Corticosteroids and Anti-Complement Therapy in Retinal Diseases

Corneal Crosslinking: The Standard Protocol

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