Corneal Collagen Cross Linking With Photo-Activated Chromophore for keratitis (PACK-CXL) As AdjunctiveTherapy for Infectious Keratitis

Abstract

Background : The aim of this work is to evaluate efficacy and safety of corneal collagen cross linking as adjunctive therapy for treating infectious keratitis. Methods: This is a randomized prospective controled clinical trial. Seventy eight (78) eyes with clinically suspected infectious keratitis were enrolled in this study. The range of age of the enrolled patients was more than or equal to18 years. They were randomly classified into two groups each of 39 eyes, Group A(control group): received topical appropriate conventional broad spectrum antimicrobial therapy alone based on sensitivity reports and Group B: received combined topical appropriate conventional broad spectrum antimicrobial therapy based on sensitivity reports and corneal collagen cross linking for infectious keratitis (PACK-CXL). Identification of organisms was done by lab study before treatment. Corneal healing was evaluated by corneal examination and anterior segment OCT ( AS-OCT). Written informed consent was obtained from all participants and the study was approved by the research ethical committee of Faculty of Medicine, Zagazig and Cairo University. The work has been carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki) for studies involving humans. Results: Complete healing and resolution (Successful treatment) was observed in 76.9 % of eyes and 97.4 % of patients in groups (A & B), respectively. They showed a statistically highly significant difference (P <0.001). Mean resolution period was 10.87±3.28 and 7.02±2 weeks in group (A & B), respectively, with statistically significant difference (P = 0.002) between both groups, being shorter in group (B).Only 2.6% of our cases had resistance to treatment in CXL compared to group A, who had 23.1% of resistance. There was no statistically significant difference between both groups as regards complications of treatment. Conclusions: PACK-CXL is a promising , non-invasive and available treatment option. It has a synergistic effect with antimicrobial treatment that gives a good outcome results in treatment of infectious keratitis. Also, it avoids the antibiotics resistance that has become rapidly spreading worldwide.

Corneal Cross-Linking: The Evolution of Treatment for Corneal Diseases

“…It was noted that a higher proportion of patients in the group receiving combination treatment of antibiotics with PACK-CXL experienced complete resolution of ulcers (97.4 vs 76.9%, p-value<0.001). Additionally, the mean resolution period was shorter in patients treated with PACK-CXL (7.02 ± 2 weeks vs 10.87 ± 3.28 weeks, p-value 0.002) (Tawfeek et al, 2020). Knyazer and colleagues have reported that additional PACK-CXL significantly reduces time to epithelial healing in ulcers up to 4 mm in size when using accelerated PACK-CXL and standardfluence of 5.4 J/cm 2 (Knyazer et al, 2020).…”

“…It was noted that a higher proportion of patients in the group receiving combination treatment of antibiotics with PACK-CXL experienced complete resolution of ulcers (97.4 vs 76.9%, p -value<0.001). Additionally, the mean resolution period was shorter in patients treated with PACK-CXL (7.02 ± 2 weeks vs 10.87 ± 3.28 weeks, p -value = 0.002) ( Tawfeek et al, 2020 ).…”