Ultraviolet A/Riboflavin Collagen Cross-Linking for Treatment of Moderate Bacterial Corneal Ulcers

Bamdad, Shahram; Malekhosseini, Hossein; Khosravi, Amir

doi:10.1097/ico.0000000000000375

Cited by 61 publications

(39 citation statements)

References 29 publications

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“…Bamdad et al randomized 32 patients with moderate bacterial keratitis to receive either CXL plus standard therapy or standard therapy alone. 119 Two weeks after the treatment, those receiving CXL had a lower mean grade of ulcer (0.69 vs 1.70; P =0.001), smaller area of epithelial defects ( P =0.001), and smaller area of infiltrate ( P <0.001) than those receiving the standard therapy alone. Mean treatment duration was also shorter in the CXL group ( P <0.001).…”

Section: Future Directionsmentioning

confidence: 92%

Update on the Management of Infectious Keratitis

2017

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Infectious keratitis is a major global cause of visual impairment and blindness, often affecting marginalized populations. Proper diagnosis of the causative organism is critical, and while culture remains the prevailing diagnostic tool, newer techniques such as in vivo confocal microscopy are helpful for diagnosing fungal keratitis and Acanthameoba. Next generation sequencing holds the potential for early and accurate diagnosis even for organisms that are difficult to culture by conventional methods. Topical antibiotics remain the best treatment for bacterial keratitis, and a recent review found all commonly prescribed topical antibiotics to be equally effective. However outcomes remain poor secondary to corneal melting, scarring and perforation. Adjuvant therapies aimed at reducing the immune response responsible for much of the morbidity associated with keratitis include topical corticosteroids. The large, randomized controlled Steroids for Corneal Ulcers trial found that while steroids provided no significant improvement overall, they did appear beneficial for ulcers that were central, deep or large, non-Nocardia or classically invasive P. aeruginosa, patients with low baseline vision, and when started early after the initiation of antibiotics. Fungal ulcers often have worse clinical outcomes than bacterial ulcers, with no new treatments since the 1960’s when topical natamycin was introduced. The randomized controlled Mycotic Ulcer Treatment Trial showed a benefit of topical natamycin over topical voriconazole for fungal keratitis, particularly among those caused by Fusarium. The second Mycotic Ulcer Treatment Trial showed that oral voriconazole did not improve outcomes overall although there may have been some effect among Fusarium ulcers. Given an increase in non-serious adverse events the authors concluded that they could not recommend oral voriconazole at this time. Viral keratitis differs from bacterial and fungal cases in that is often recurrent and is common in developed countries. The first Herpetic Eye Disease Study (HEDS) showed a significant benefit of topical corticosteroids and oral acyclovir for stromal keratitis. HEDS II showed that oral acyclovir decreased the recurrence of any type of HSV keratitis by approximately half. Future strategies to reduce the morbidity associated with infectious keratitis are likely to be multidimensional with adjuvant therapies aimed at modifying the immune response to infection holding the greatest potential to improve clinical outcomes.

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Section: Future Directionsmentioning

confidence: 92%

Update on the Management of Infectious Keratitis

2017

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“…As CXL has been an effective and a relatively safe modality in the management of keratoconus, investigators have tried it for other different disorders of the cornea such as corneal edema [12,13], bullous keratopathies [8], Fuchs dystrophy [9], non-healing corneal ulcers [14], corneal erosive disorders and infectious melting keratitis [9,10,13].…”

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%

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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“…The second randomised clinical trial of PACK-CXL was published by Bamdad et al 46. They reported findings on 32 participants with culture-proven bacterial keratitis.…”

Section: Corneal Collagen Cross-linkingmentioning

confidence: 99%

Established and emerging ancillary techniques in management of microbial keratitis: a review

2016

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Microbial keratitis is a sight-threatening condition and an ocular emergency, because of the potential for rapid progression. Intensive topical antimicrobials are the mainstay and the gold standard of treatment for microbial keratitis. However, despite appropriate diagnosis and therapy, treatment failure is still common, and can result in significant morbidity due to corneal perforation and/or scarring. For this reason, clinicians continue to seek novel treatment techniques in order to expand the armamentarium of tools available to manage microbial keratitis, and in doing so improve clinical outcomes. In this review, we examine the evidence for some established, as well as a few emerging ancillary techniques used to manage microbial keratitis. These include topical corticosteroids, corneal collagen cross-linking, intrastromal antimicrobials, amniotic membrane transplantation and miscellaneous other techniques. Of these, collagen cross-linking shows some promise for selected cases of infectious keratitis, although more research in the area is required before it is accepted as mainstream treatment for this potentially blinding condition.

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Ultraviolet A/Riboflavin Collagen Cross-Linking for Treatment of Moderate Bacterial Corneal Ulcers

Cited by 61 publications

References 29 publications

Update on the Management of Infectious Keratitis

Update on the Management of Infectious Keratitis

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

Established and emerging ancillary techniques in management of microbial keratitis: a review

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