Corneal Cross-linking as an Adjunct for The Management of Refractory Fungal Keratitis

Bamdad, Shahram; Khalili, Mohammad Reza; Khosravi, Amir; Attarzade, Adel; Movahedan, Hossein; Nejabat, Mahmood

doi:10.4103/meajo.meajo_130_19

Cited by 8 publications

(3 citation statements)

References 36 publications

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“…PACK-CXL in conjunction with topical therapy has shown success in bacterial keratitis but less so in fungal keratitis [83][84][85]. Although some studies have shown it equivalent to intrastromal voriconazole [86], others have shown an increased risk of perforations and an increased need for therapeutic keratoplasty [87]. Future larger studies are required to determine a more consistent answer.…”

Section: Collagen Cross-linkingmentioning

confidence: 99%

Therapy for contact lens-related ulcers

Jeang

Tuli

2022

Current Opinion in Ophthalmology

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Purpose of reviewThe current review covers the current literature and practice patterns of antimicrobial therapy for contact lens-related microbial keratitis (CLMK). Although the majority of corneal ulcers are bacterial, fungus and acanthamoeba are substantial contributors in CLMK and are harder to treat due to the lack of commercially available topical medications and low efficacy of available topical therapy.Recent findingsTopical antimicrobials remain the mainstay of therapy for corneal ulcers. Fluoroquinolones may be used as monotherapy for small, peripheral bacterial ulcers. Antibiotic resistance is a persistent problem. Fungal ulcers are less responsive to topical medications and adjunct oral or intrastromal antifungal medications may be helpful. Acanthamoeba keratitis continues to remain a therapeutic challenge but newer antifungal and antiparasitic agents may be helpful adjuncts. Other novel and innovative therapies are being studied currently and show promise.SummaryContact lens-associated microbial keratitis is a significant health issue that can cause vision loss. Treatment remains a challenge but many promising diagnostics and procedures are in the pipeline and offer hope.

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Section: Collagen Cross-linkingmentioning

confidence: 99%

Therapy for contact lens-related ulcers

Jeang

Tuli

2022

Current Opinion in Ophthalmology

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“…Fungal keratitis is painful and may require hospitalization for intensive medical treatment and/or surgical interventions. Treatment of fungal keratitis with systemic and topical antifungal agents has been only partially successful due to the high resistance to antifungal agents ( 2 ). Natamycin and voriconazole are not sufficient for treating non-responsive fungal keratitis due to their limited efficacy ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

Local application of silver nitrate as an adjuvant treatment before deep lamellar keratoplasty for fungal keratitis poorly responsive to medical treatment

Ding,

Gao,

Tan

et al. 2024

Front. Med.

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ObjectiveThe purpose of this study is to evaluate the efficacy and safety of the local application of silver nitrate (LASN) as an adjuvant treatment before deep lamellar keratoplasty (DLKP) for fungal keratitis responding poorly to medical treatment.MethodsA total of 12 patients (12 eyes) with fungal keratitis responding poorly to medical treatment (for at least 2 weeks) were included. LASN was performed using 2% silver nitrate, the ulcer was cleaned and debrided, and then, the silver nitrate cotton stick was applied to the surface of the ulcer for a few seconds. The effect of LASN was recorded. The number of hyphae before and after treatment was determined by confocal microscope. After the condition of the ulcer improved, DLKP was performed. Fungal recurrence, best-corrected visual acuity (BCVA), loose sutures, and endothelial cell density (ECD) were recorded in detail.ResultsClinical resolution of corneal infiltration and edema was observed, and the ulcer boundary became clear in all 12 patients after 7–9 days of LASN. Confocal microscopy showed that the number of hyphae was significantly reduced. Ocular pain peaked on days 1 and 2 after treatment, and 9 patients (75%, day 1) and 1 patient (8.3%, day 2) required oral pain medication. During the follow-up period after DLKP, no fungal recurrence and loose sutures were observed. After the operation, the BCVA of all patients improved. The mean corneal ECD was 2,166.83 ± 119.75 cells/mm2.ConclusionThe LASN was safe and effective and can be well tolerated by patients. Eye pain can be relieved quickly. LASN as an adjuvant treatment before DLKP might be a promising therapeutic strategy.

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“…There appears to be no benefit of adjuvant CXL in the primary treatment of moderate filamentous fungal ulcers and it may result in decreased visual acuity Mikropoulos et al 2019 130 (Case report) Intraoperative PACKCXL during PKP for the management of fungal keratitis in an immunocompromised patient 1 Purpureocillium lilacinum 9 mW/cm 2 for 10 minutes (total 5.4 J/cm 2 ) No signs of infection were noted, and the graft remained clear during the 9-month follow-up period Wei et al 2019 131 (Randomized controlled study) Evaluation of corneal cross-linking as adjuvant therapy for the management of fungal keratitis 21 Aspergillus in 8 eyes, Fusarium in 5, and unidentified in 7 cases (1 missing) 3 mW/cm 2 for 30 minutes (total 5.4 J/cm 2 ) CXL accelerated healing, shortened the treatment duration, and minimized the need for medications and surgery. CXL is an effective procedure and adjuvant therapy for managing fungal keratitis Bamdad et al 2020 132 (Prospective interventional) Corneal Cross-linking as an Adjunct for The Management of Refractory Fungal Keratitis 9 Aspergillus in 4 eyes, Fusarium in 4, and candida in 1 3 mW/cm 2 for 30 minutes (total 5.4 J/cm 2 ) Four out of 9 eyes showed good response and infection was completely halted and scared down. Five out of 9 patients showed no response, and therapeutic PKP was performed to preserve the globe.…”

Section: Introductionmentioning

confidence: 99%

Fungal Keratitis: Diagnosis, Management, and Recent Advances

Awad,

Ghaith,

Awad

et al. 2024

OPTH

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Fungal keratitis is one of the major causes of microbial keratitis that may lead to corneal blindness. Many problems related to diagnosis and therapy are encountered in fungal keratitis, including difficulty in obtaining laboratory diagnoses and the availability and efficacy of antifungal medications. Intensive and prolonged use of antifungal topical preparations may not be enough. The use of antifungal medications is considered the main treatment for fungal keratitis. It is recommended to start antifungal therapy after confirmation of the clinical diagnosis with a smear or positive cultures. Topical application of antifungal medications is a mainstay for the treatment of fungal keratitis; however, systemic, intra-stromal, or intra-cameral routes may be used. Therapeutic keratoplasty is the main surgical procedure approved for the management of fungal keratitis with good success rate. Intrastromal corneal injection of antifungal medications may result in steady-state drug levels within the corneal tissue and prevent intervals of decreased antifungal drug concentration below its therapeutic level. In cases of severe fungal keratitis with deep stromal infiltration not responding to treatment, intracameral injection of antifungal agents may be effective. Collagen cross-linking has been proposed to be beneficial for cases of fungal keratitis as a stand-alone therapy or as an adjunct to antifungal medications. Although collagen cross-linking has been extensively studied in the past few years, its protocol still needs many modifications to optimize UV fluence levels, irradiation time, and concentration of riboflavin to achieve 100% microbial killing.

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Corneal Cross-linking as an Adjunct for The Management of Refractory Fungal Keratitis

Cited by 8 publications

References 36 publications

Therapy for contact lens-related ulcers

Therapy for contact lens-related ulcers

Local application of silver nitrate as an adjuvant treatment before deep lamellar keratoplasty for fungal keratitis poorly responsive to medical treatment

Fungal Keratitis: Diagnosis, Management, and Recent Advances

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