Corneal Collagen Cross-Linking for Infectious Keratitis

Papaioannou, Lamprini; Miligkos, Michael; Papathanassiou, Miltiadis

doi:10.1097/ico.0000000000000644

Cited by 138 publications

(88 citation statements)

References 78 publications

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“…Considering its ability in decreasing corneal edema and also its antibacterial effects, combined riboflavin/UV-A is especially useful for such cases. Such a therapeutic effect of corneal cross-linking has been reported in two cases of combined bullous keratopathy and infectious keratitis that have been resistant to traditional topical therapy [11].…”

Section: Discussionmentioning

confidence: 99%

“…Corneal CXL with UV-A and riboflavin has been used as a new modality in the management of keratoconus to halt the progression of the disease, to prevent visual loss and to postpone the need for surgical intervention. Because CXL has been an effective and a relatively safe modality in the management of keratoconus, it has been used empirically in several other disorders of the cornea such as corneal edema [8], Fuchs dystrophy [9], nonhealing corneal ulcers and infectious melting keratitis [10,11]. This prospective interventional study was conducted to evaluate the effects of therapeutic corneal CXL with UV-A and riboflavin for the treatment of patients with refractory bacterial and HSV keratitis.…”

Section: Introductionmentioning

confidence: 99%

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Corneal Collagen Cross-linking for Treatment of Bacterial and Herpetic Keratitis

Khalili

Jahadi

Karimi

et al. 2017

JCDR

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Introduction: Optimal management of infective keratitis is a formidable challenge and subject of ongoing studies. Recently, Collagen Cross-Linking (CXL) of the cornea has been considered to be a new effective therapeutic approach for resistant infectious keratitis.Aim: Aim of the study was to evaluate the effectiveness of CXL with Ultraviolet-A (UV-A) and riboflavin for treatment of the refractory bacterial and Herpes Simplex Virus (HSV) keratitis. Materials and Methods:In this prospective interventional study, eight patients with diagnosis of infectious keratitis who were referred to Khalili Hospital eye emergency room, between 2014 and 2015 were included in the study. There were six patients with bacterial keratitis and two patients with HSV keratitis; they were resistant to conventional treatment and underwent CXL. Response to the treatment was considered as good if rapid epithelialization and rapid decrease in stromal infiltration occurred.Results: Microbial culture in the bacterial keratitis group showed coagulase negative Staphylococcus in two patients, Staphylococcus aureus in one patient, mixed infection in one patient and Pseudomonas aeruginosa in two patients. Good response and rapid epithelialization and resolution of stromal infiltration were seen in the four out of six eyes. Two patients showed no response and underwent penetrating keratoplasty for eradication of infection. Furthermore, one patient showed a good response to CXL in the HSV keratitis group and another patient had a relative response but recurrence occurred.Conclusion: Although, CXL seems promising in the treatment of patients with refractory bacterial keratitis, but in some cases, it is ineffective. CXL may be an alternative treatment for refractory cases of HSV keratitis but recurrence is possible.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Corneal Collagen Cross-linking for Treatment of Bacterial and Herpetic Keratitis

Khalili

Jahadi

Karimi

et al. 2017

JCDR

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“…Vendar pa je v odsotnosti primerjalnih študij, predvsem randomiziranih kontroliranih raziskav in glede na dejstvo, da gre pri večini raziskav, opravljenih s pomočjo CXL, za poročila o posameznem primeru oziroma o več primerih, je sposobnost sprejeti ustrezne sklepe o učinkovitosti CXL v primerjavi z zdravljenjem samo z antibiotiki, omejena. 3 Makdoumi je leta 2010 opisal zdravljenje sedmih oči s težkim vnetnim keratitisom in mehčanjem roženice, zdravljenih s CXL. Razen pri enem, je v vseh primerih prišlo do izboljšanja simptomov v 24 urah.…”

Section: In Okužbe Roženiceunclassified

Zdravljenje Okužb Roženice S Prečnim Povezovanjem Kolagenih Vlaken

Silih

2016

SlovMedJour

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Zdravljenje okužb roženice s prečnim povezovanjem kolagenih vlakencorneal collagen cross-linking for infectious keratitis mirna Štabuc Šilih IzvlečekPrečno povezovanje kolagenih vlaken roženice z ultravijolično svetlobo poveča stabilnost roženice z uporabo fotosenzitivne snovi -riboflavina (vitamina B2) in ultravijoličnih žarkov A. Osnovna indikacija je napredujoči keratokonus, poseg pa se v svetu vse pogosteje uporablja. Ker gre pri tem postopku za fiziološke spremembe vsega vezivnega tkiva, so bile predlagane še dodatne indikacije. Te so ektazija po operaciji, bulozna keratopatija in predvsem, najbolj zanimiva, infekcijski keratitis.Okužbe roženice lahko brez ustreznega zdravljenja povzročijo slepoto. Vendar je tudi takojšnje in ustrezno antimikrobno zdravljenje odvisno od senzitivnosti in rezistence mikroorganizmov.Prispevek opisuje sedanje možnosti zdravljenja okužb roženice s prečnim povezovanjem kolagenih vlaken.Ta način zdravljenja bo morda postal pomemben, vendar pa ostajajo odprta še mnoga neodgovorjena vprašanja. Odgovore nanje naj bi dali rezultati večjih, prospektivnih primerjalnih raziskav. AbstractCorneal collagen cross-linking increases the stability of the cornea through the use of the photosensitive material-riboflavin (vitamin B2) and ultraviolet A radiation. Progressive keratoconus is the most common indication and the frequency of these procedures is increasing worldwide. As cross-links in the cornea are a physiological principle of all connective tissues, additional indications were proposed. These include post-refractive surgery ectasia, bullous keratopathy, and, infectious keratitis.Without proper antimicrobial therapy, infectious keratitis can lead to blindness. But even prompt initial management with appropriate antimicrobial treatment depends on microorganism sensitivity and resistance. This article presents current data regarding the use of corneal collagen cross-linking in the treatment of corneal infections. This treatment modality may become important, but unanswered questions remain. Larger, prospective comparative studies should provide the answers. UvodVnetni keratitis lahko brez ustreznega antimikrobnega zdravljenja privede do slepote. Tudi če ga odkrijemo v začetni fazi in pravilno zdravimo, lahko napreduje in privede do mehčanja roženice. Zaradi agresivne narave roženičnih patogenov in nevarnosti odpornosti na antibiotike je potrebno razviti nove načine obvladovanja tega hitro napredujočega stanja.1 O prečnem povezovanju kolagenih vlaken roženice z ultravijolično svetlo-

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“…These circumstances have made research into the development of novel therapy approaches essential. Photodynamic inactivation (PDI) was rarely used as a treatment option for ocular infections, although other photodynamic therapy procedures including corneal crosslinking with riboflavin and ultraviolet light (UV-crosslinking), are established as a treatment for specific corneal diseases such as keratoconus (5)(6)(7)(8)(9)(10). UV-crosslinking is a photochemical crosslinking of fibers within the corneal tissue.…”

Section: Introductionmentioning

confidence: 99%

Bacterial keratitis: Photodynamic inactivation reduced experimental inflammation

Deichelbohrer

Seitz

et al. 2017

Exp Ther Med

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Abstract. The successful treatment of bacterial keratitis remains an unsolved clinical problem. The current study aimed to establish a murine keratitis model and to investigate the effect of chlorin e6 (Ce6) and photodynamic inactivation (PDI) on corneal inflammation. The cornea of anesthetized mice was scratched and covered with a bacterial suspension of Pseudomonas aeruginosa. A paste containing Ce6 was applied to the cornea with subsequent exposure to specified light. Two days later the animals were sacrificed, and the globes were processed for light microscopy. Evaluation parameters were the maximal corneal thickness and the severity of the hypopyon. The maximal corneal thickness of 290±16 µm in the infected and untreated group was significantly reduced to 220±8 µm in the infected and treated group (P<0.05). In addition, the hypopyon was less severe in the infected and treated group. In conclusion, the present study indicates that PDI using Ce6 may be a potential approach to treat patients suffering with severe bacterial keratitis.

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Corneal Collagen Cross-Linking for Infectious Keratitis

Abstract: CXL seems promising in the management of infectious keratitis, excluding viral infections. However, more randomized controlled trials are required to assess its efficacy.

Cited by 138 publications

References 78 publications

Corneal Collagen Cross-linking for Treatment of Bacterial and Herpetic Keratitis

Corneal Collagen Cross-linking for Treatment of Bacterial and Herpetic Keratitis

Zdravljenje Okužb Roženice S Prečnim Povezovanjem Kolagenih Vlaken

Bacterial keratitis: Photodynamic inactivation reduced experimental inflammation

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