Rose Bengal Photodynamic Antimicrobial Therapy: A Review of the Intermediate-Term Clinical and Surgical Outcomes

Sepulveda-Beltran, Paula A.; Levine, Harry; Altamirano, Diego; Martínez, J.; Durkee, Heather; Mintz, Keenan J.; Leblanc, Roger M.; Tóthová, Jana DʼAmato; Miller, Darlene; Parel, Jean-Marie A.; Amescua, Guillermo

doi:10.1016/j.ajo.2022.08.004

Cited by 15 publications

(9 citation statements)

References 61 publications

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“…In vitro susceptibility of RB-PDAT was performed as previously described . Nine genetically confirmed clinical VIM-GES-CRPA isolates from patients were isolated and grown in blood agar plates (A10; Hardy Diagnostics) and placed in an incubator for 48 hours at 3°C.…”

Section: Methodsmentioning

confidence: 99%

“…One such therapy is rose bengal–photodynamic antimicrobial therapy (RB-PDAT), which uses a diagnostic ophthalmic dye activated with green light to generate antimicrobial oxygen-free radicals that damage the DNA and the cytoplasmic membrane of the bacteria . Studies of RB-PDAT have shown in vitro and in vivo efficacy against a wide variety of ocular microorganisms.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Features and Treatment Outcomes of Carbapenem-Resistant Pseudomonas aeruginosa Keratitis

Tribin,

Lieux,

Maestre-Mesa

et al. 2024

JAMA Ophthalmol

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ImportanceEvaluation of the microbiological diagnostic profile of multidrug-resistant Pseudomonas aeruginosa keratitis and potential management with rose bengal–photodynamic antimicrobial therapy (RB-PDAT) is important.ObjectiveTo document the disease progression of carbapenemase-resistant P aeruginosa keratitis after an artificial tear contamination outbreak.Design, Setting, and ParticipantsThis retrospective observation case series included 9 patients 40 years or older who presented at Bascom Palmer Eye Institute and had positive test results for multidrug-resistant P aeruginosa keratitis between January 1, 2022, and October 31, 2023.Main Outcomes and MeasuresEvaluation of type III secretion phenotype, carbapenemase-resistance genes blaGES and blaVIM susceptibility to antibiotics, and in vitro and in vivo outcomes of RB-PDAT against multidrug-resistant P aeruginosa keratitis.ResultsAmong the 9 patients included in the analysis (5 women and 4 men; mean [SD] age, 73.4 [14.0] years), all samples tested positive for exoU and carbapenemase-resistant blaVIM and blaGES genes. Additionally, isolates were resistant to carbapenems as indicated by minimum inhibitory concentration testing. In vitro efficacy of RB-PDAT indicated its potential application for treating recalcitrant cases. These cases highlight the rapid progression and challenging management of multidrug-resistant P aeruginosa. Two patients were treated with RB-PDAT as an adjuvant to antibiotic therapy and had improved visual outcomes.Conclusions and RelevanceThis case series highlights the concerning progression in resistance and virulence of P aeruginosa and emphasizes the need to explore alternative therapies like RB-PDAT that have broad coverage and no known antibiotic resistance. The findings support further investigation into the potential effects of RB-PDAT for other multidrug-resistant microbes.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical Features and Treatment Outcomes of Carbapenem-Resistant Pseudomonas aeruginosa Keratitis

Tribin,

Lieux,

Maestre-Mesa

et al. 2024

JAMA Ophthalmol

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“…[ 46 ] These results appear to persist in a longer-term follow-up and the crosslinking effect appears to increase graft survival at 1 year postoperatively. [ 47 ]…”

Section: Applicationsmentioning

confidence: 99%

A comprehensive review on corneal crosslinking

Naranjo,

Manche

2024

Taiwan Journal of Ophthalmology

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Corneal crosslinking (CXL) represents a paradigm shift in the management of corneal ectatic disorders. Before CXL was introduced, patients would need specialty contact lenses and possible corneal transplantation. CXL involves a biochemical reaction in which ultraviolet A light is used in conjunction with Riboflavin to form crosslinks in between corneal stromal collagen. This leads to strengthening and stabilizing of the collagen lamellae, resulting in mechanical stiffening of the cornea. Multiple protocols have been proposed including epithelium on versus off and varying light intensity and duration of treatment. All protocols appear to be safe and effective with few reported complications including infection, stromal haze, scarring, and endothelial toxicity. Overall, CXL has demonstrated to halt the progression of the disease clinically and in keratometry readings and improve the quality of life for patients. It is a minimally invasive, cost-effective procedure that can be performed in an outpatient setting with a fast recovery time and long-lasting results.

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“…37 In addition, some routinely administer topical corticosteroids after the newly described surgical procedure of Rose Bengal Photodynamic Antimicrobial Therapy, although others insist on withholding steroids after this treatment (personal communication, Guillermo Amescua). 38 The evidence base for miltefosine and Rose Bengal Photodynamic Antimicrobial Therapy-including the benefit of adjuvant steroids and their optimal timing, duration, and dosing-is weak. In general, although it is unclear if and when it is safe to administer topical corticosteroids, some reports have suggested waiting for at least 2 weeks after initiation of antiamoebic therapy with a biguanide agent.…”

Section: Amoebic Keratitismentioning

confidence: 99%

Steroids in the Management of Infectious Keratitis

Keenan

2023

Cornea

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Purpose: To summarize the evidence base on the use of topical corticosteroids for infectious keratitis. Methods: Narrative review. Results: Infectious keratitis is a painful condition that often results in visually significant corneal stromal scarring, even when antimicrobial therapy is successful. Corticosteroids may reduce inflammation and subsequent scar formation and while relieving the acute ocular pain associated with a corneal ulcer. However, corticosteroids also reduce the host immune response, which could hinder the ability to clear infection. The safety and effectiveness of corticosteroids depends to a large part on the efficacy of the antimicrobials being used to treat the underlying infection. Randomized trials have found that corticosteroids are safe and effective for herpetic keratitis when used with appropriate antiviral therapy, and are safe for bacterial keratitis when used with broad spectrum topical antibiotics. The effectiveness of corticosteroids for bacterial keratitis has not been shown conclusively, although more advanced bacterial corneal ulcers may do better with corticosteroids. No randomized trials have assessed the safety and effectiveness of steroids for fungal or acanthamoeba keratitis. Animal studies suggest corticosteroids may be harmful in fungal keratitis, and observational human studies have found that steroids are harmful for fungal and acanthamoeba keratitis when started prior to anti-amoebics. Conclusions: Topical corticosteroids, when used as an adjunct to antimicrobial therapy, may be beneficial if the antimicrobial being used can effectively clear or suppress the infection, such as in bacterial and herpetic keratitis. Randomized trials would be helpful to further delineate the role of corticosteroids for infectious keratitis.

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Rose Bengal Photodynamic Antimicrobial Therapy: A Review of the Intermediate-Term Clinical and Surgical Outcomes

Cited by 15 publications

References 61 publications

Clinical Features and Treatment Outcomes of Carbapenem-Resistant Pseudomonas aeruginosa Keratitis

Clinical Features and Treatment Outcomes of Carbapenem-Resistant Pseudomonas aeruginosa Keratitis

A comprehensive review on corneal crosslinking

Steroids in the Management of Infectious Keratitis

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