Anterior Segment Optical Coherence Tomography in Evaluation of Severe Fungal Keratitis Infections Treated by Corneal Crosslinking

Abbouda, Alessandro; Estrada, Alejandra Rocha; Rodrı́guez, Alejandra; Alió, Jorge L.

doi:10.5301/ejo.5000424

Cited by 29 publications

(18 citation statements)

References 11 publications

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“…This study not only confirmed the previous results from Seiler and colleagues from the year 2000, but also introduced the concept that CXL might be efficient when treating corneal melts from an infectious origin. Subsequently, further clinical trials on advanced melting corneas, one meta-analysis, and multiple animal experiments confirmed those initial results [ 20 , 26 – 53 ].…”

Section: Reviewmentioning

confidence: 73%

PACK-CXL: Corneal cross-linking in infectious keratitis

2016

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BackgroundCorneal cross-linking (CXL) using ultraviolet light-A (UV-A) and riboflavin is a technique developed in the 1990’s to treat corneal ectatic disorders such as keratoconus. It soon became the new gold standard in multiple countries around the world to halt the progression of this disorder, with good long-term outcomes in keratometry reading and visual acuity. The original Dresden treatment protocol was also later on used to stabilize iatrogenic corneal ectasia appearing after laser-assisted in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK). CXL efficiently strengthened the cornea but was also shown to kill most of the keratocytes within the corneal stroma, later on repopulated by those cells.ReviewUltraviolet-light has long been known for its microbicidal effect, and thus CXL postulated to be able to sterilize the cornea from infectious pathogens. This cytotoxic effect led to the first clinical trials using CXL to treat advanced infectious melting corneal keratitis. Patients treated with this technique showed, in the majority of cases, a stabilization of the melting process and were able to avoid emergent à chaud keratoplasty. Following those primary favorable results, CXL was used to treat beginning bacterial keratitis as a first-line treatment without any adjunctive antibiotics with positive results for most patients. In order to distinguish the use of CXL for infectious keratitis treatment from its use for corneal ectatic disorders, a new term was proposed at the 9th CXL congress in Dublin to rename its use in infections as photoactivated chromophore for infectious keratitis -corneal collagen cross-linking (PACK-CXL).ConclusionPACK-CXL is now more frequently used to treat infections from various infectious origins. The original Dresden protocol is still used for this purpose. Careful modifications of this protocol could improve the efficiency of this technique in specific clinical situations regarding certain types of pathogens.

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Section: Reviewmentioning

confidence: 73%

PACK-CXL: Corneal cross-linking in infectious keratitis

2016

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“…Therapeutisch kann neben den Standardmedikamenten auch das korneale Crosslinking eingesetzt werden [4,5], dies geht aber mit einem erhöhten Risiko der Hornhauteinschmelzung einher. Aufgrund all dieser Probleme ist es deshalb selbst heute nicht sel- ten, dass eine Pilzkeratitis letztendlich zur Enukleation des Auges führt [6,7].…”

Section: Diskussionunclassified

Therapieresistente Fusarienkeratitis mit intraokularer Beteiligung – potenzielle Quellen für eine persistierende Infektion

Löffler

Holz

Herwig‐Carl

2018

Klin Monatsbl Augenheilkd

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“…Besides being an adjuvant therapy, CXL has been used as a salvage therapy for refractory infectious keratitis in various case reports and series in the literature (Iseli et al 2008;Ehlers et al 2009;Micelli Ferrari et al 2009;Kozobolis et al 2010;Makdoumi et al 2010b;Mor en et al 2010;Anwar et al 2011;Garduno-Vieyra et al 2011;Khan et al 2011;Kymionis et al 2012;Panda et al 2012;Demirci & Ozdamar 2013;Ferrari et al 2013;Li et al 2013;Mattila et al 2013;Rosetta et al 2013;Saglk et al 2013;Sorkhabi et al 2013;Abbouda et al 2014b;Arance-Gil et al 2014;Chan et al 2014;Labiris et al 2014;Shetty et al 2014). Panda et al (2012) applied CXL to seven patients with infectious corneal ulcer who did not respond after 4-12 weeks of topical antimicrobial treatment.…”

Section: Clinical Studiesmentioning

confidence: 99%

Corneal collagen cross‐linking for infectious keratitis: an update of clinical studies

Chan

Lau

Lee

et al. 2015

Acta Ophthalmologica

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ABSTRACT.Collagen cross-linking (CXL) with ultraviolet light-activated riboflavin is a corneal surface procedure developed for the treatment of keratoconus and corneal ectasia. With the known microbicidal and corneal stiffening effects of ultraviolet irradiation and photoactivated riboflavin, it has recently been introduced for the management of infectious keratitis, especially for ulcers resistant to antimicrobial therapy or associated with corneal melting. Various authors have attempted to use CXL as an adjunctive, salvage or even as the sole treatment for infectious corneal ulcers. The aim of this review was to provide a summary of the clinical studies in the literature. It is worth noting that there is still no consensus on the treatment protocol of CXL against infectious keratitis. The disparities in outcome measures, treatment protocol and study design can confound the interpretation and hamper the generalization of the study results. Based on current evidence, the role of CXL in infectious keratitis remained unclear despite the reported success in some clinical cases. Further investigations are warranted concerning the efficacy and safety of treating infectious keratitis with CXL.

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Anterior Segment Optical Coherence Tomography in Evaluation of Severe Fungal Keratitis Infections Treated by Corneal Crosslinking

Abstract: The different behavior of inflamed tissue with respect to UVA irradiance could be the main point to understand the different postoperative outcome.

Cited by 29 publications

References 11 publications

PACK-CXL: Corneal cross-linking in infectious keratitis

PACK-CXL: Corneal cross-linking in infectious keratitis

Therapieresistente Fusarienkeratitis mit intraokularer Beteiligung – potenzielle Quellen für eine persistierende Infektion

Corneal collagen cross‐linking for infectious keratitis: an update of clinical studies

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