High fluence PACK-CXL as adjuvant treatment for advanced Acanthamoeba keratitis

Pettersson, Mehrdad Nateghi; Lagali, Neil; Mortensen, Jes; Jofré, Victor

doi:10.1016/j.ajoc.2019.100499

Cited by 16 publications

(9 citation statements)

References 32 publications

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“…The results showed that in bacterial or fungal keratitis, PACK-CXL may be a useful adjunct therapy for reducing the time to complete corneal healing, but PACK-CXL was not useful compared to SAT alone in reducing the infiltrate size, improving visual acuity, or reducing the risk of adverse effects, such as the worsening of infectious keratitis, corneal melt, or perforations [ 46 ]. The microbicidal effect of PACK-CXL likely arises from ultraviolet A (UVA) induced DNA damage and reactive oxygen species release [ 15 , 47 , 48 ], while pain reduction may be secondary to the suppression of inflammation and nociception by subepithelial nerves [ 47 ]. PACK-CXL has been used along with standard antimicrobial therapy to treat persistent cases of Acanthamoeba spp.…”

Section: Resultsmentioning

confidence: 99%

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Challenges in Acanthamoeba Keratitis: A Review

Varacalli

Zazzo

Mori

et al. 2021

JCM

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To review challenges in the diagnosis and management of Acanthamoeba keratitis (AK), along with prognostic factors, in order to help ophthalmologists avoid misdiagnosis, protracted treatment periods, and long-term negative sequelae, with an overarching goal of improving patient outcomes and quality of life, we examined AK studies published between January 1998 and December 2019. All manuscripts describing clinical manifestations, diagnosis, treatment, prognosis, and challenges in short- and long-term management were included. The diagnosis of AK is often challenging. An increased time between symptom onset and the initiation of appropriate therapy is associated with poorer visual outcomes. The timely initiation of standardized antiamoebic therapies improves visual outcomes, decreases the duration of treatment, and reduces the chances of needing surgical intervention. In clinical practice, AK diagnosis is often missed or delayed, leading to poorer final visual outcomes and a negative impact on patient morbidity and quality of life.

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Section: Resultsmentioning

confidence: 99%

“…PACK-CXL has been used along with standard antimicrobial therapy to treat persistent cases of Acanthamoeba spp. infection [ 47 ]; however, there is currently insufficient evidence to support its use in the setting of AK [ 46 , 49 , 50 ].…”

Section: Resultsmentioning

confidence: 99%

Challenges in Acanthamoeba Keratitis: A Review

Varacalli

Zazzo

Mori

et al. 2021

JCM

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“…Nateghi Petterson et al [54] performed accelerated PACK-CXL with higher total fluence (7.2 J/cm 2 ) in a case refractive to pharmacology and a previous PACK-CXL procedure (5.6 J/cm 2 ) [54]. This was effective despite the discontinuation of antiprotozoal drugs due to potential negative side effects on epithelial wound healing.…”

Section: Acanthamoeba Keratitismentioning

confidence: 99%

“…There is limited evidence for the use of PACK-CXL against Acanthamoeba keratitis. Laboratory models [69,70,97] of the effects of PACK-CXL on Acanthamoeba keratitis have shown poorer results than the outcomes of clinical cases [52,54,74,98]. This may be due to several reasons, such as difficulty in exposing their Acanthamoeba samples to antiprotozoal medication in a similar way, lack of culture and/or treatment media analogous to the human cornea, assessing effectiveness through requiring rapid eradication, or infecting corneae with protozoal numbers over typical, acute keratitis.…”

Section: Acanthamoeba Keratitismentioning

confidence: 99%

Use of corneal cross-linking beyond keratoconus: a systemic literature review

Achiron

Knyazer

Elhaddad

et al. 2023

Graefes Arch Clin Exp Ophthalmol

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Purpose The success of corneal collagen cross-linking in altering keratoconus' clinical course has driven a search for further uses of this procedure. This literature review aims to analyze the scientific evidence available for the benefit of cross-linking in the management of ophthalmic diseases other than progressive keratoconus or ectasia induced by corneal refractive procedures. Methods A systemic literature review. ResultsWe reviewed 97 studies. We found that collagen cross-linking can limit the progression of several other corneal ectasias, thus reducing and limiting the need for keratoplasty. Collagen cross-linking also can reduce the refractive power of the cornea and can be considered for a moderate degree of bacterial keratitis or when the organism is unidentified, which is refractive to antibiotics alone. However, the comparative rarity of these procedures has limited the extent of evidence. In fungal, Acanthamoeba, and herpes virus keratitis, the evidence is inconclusive of the safety and efficacy of cross-linking. Conclusion Current clinical data is limited, and laboratory data has not fully correlated with published clinical data.

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“…PACK-CXL is an area of ongoing research and development. Higher UV fluences [79,80,81 ▪ ], and the use of alternative chromophore and light wavelength combinations, such as rose bengal/532 nm green light are being investigated as potentially more effective treatments of infectious keratitis of bacterial, fungal or parasitic origin [82–85], although further investigation and optimization are necessary before widespread clinical implementation can occur.…”

Section: High-fluence Eramentioning

confidence: 99%

Expanding indications for corneal cross-linking

Hafezi

Torres-Netto

Hillen

2023

Current Opinion in Ophthalmology

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Purpose of reviewThe aim of this study was to summarize the recent developments in corneal cross-linking (CXL) and its indications, including corneal ectasias, refractive surgery and infectious keratitis. Recent findingsAdvances in CXL technology, such as the use of higher-intensity LED ultraviolet (UV) light sources and a better understanding of the UV-riboflavin photochemical reaction, have enabled safer and more effective methods of cross-linking thin and ultra-thin corneas, and more effective accelerated transepithelial/'epi-on' CXL procedures that are beginning to supplant the Dresden protocol as the 'gold standard' CXL method. CXL is also being used in combination with laser surgery, not only to expand the patient base who can receive refractive surgery, but also to help rehabilitate vision in patients with ectasia. CXL, and CXL combined with photorefractive keratectomy (PRK), can result in corneal flattening of 1--2 D, and corneal regularization of 4--5 D, respectively. Finally, photoactivated chromophore for keratitis-corneal cross-linking (PACK-CXL) has been shown to be an effective therapy for infectious keratitis, both alone, and in combination with antimicrobial drugs. SummaryCXL has evolved from a single technique to treat a single corneal ectasia, keratoconus, to several techniques with several indications, spanning a spectrum of corneal ectasias, as well as visual rehabilitation, refractive procedures and infectious keratitis treatment.

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High fluence PACK-CXL as adjuvant treatment for advanced Acanthamoeba keratitis

Cited by 16 publications

References 32 publications

Challenges in Acanthamoeba Keratitis: A Review

Challenges in Acanthamoeba Keratitis: A Review

Use of corneal cross-linking beyond keratoconus: a systemic literature review

Expanding indications for corneal cross-linking

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