Corneal cross-linking guards against infectious keratitis: an experimental model

Marrie, Ayah; Abdullatif, Abdussalam M; Dine, Sherief Gamal El; Yehia, Rania; Saied, Randa; Tolba, Doaa Ahmed

doi:10.1007/s10792-022-02522-z

Cited by 4 publications

(1 citation statement)

References 52 publications

(51 reference statements)

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“…More in vitro studies support this result ( Lu et al, 2023 ). In vivo studies examining high fluences on infectious keratitis, however, are scarce ( Nateghi Pettersson et al, 2019 ; Knyazer et al, 2021 ; Hafezi et al, 2022a ; Awad et al, 2022 ; Hafezi et al, 2022b ; Marrie et al, 2023 ), mostly on animal models or human case reports. Our first aim is to show the therapeutic benefit of high fluence PACK-CXL in a case series.…”

Section: Introductionmentioning

confidence: 99%

Accelerated high fluence photoactivated chromophore for infectious keratitis—corneal cross-linking (PACK-CXL) at the slit lamp: a pilot study

Olshaker,

Achiron,

Chorny

et al. 2023

Front. Pharmacol.

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Introduction: Photoactivated Chromophore for Infectious Keratitis-Corneal Cross-Linking (PACK-CXL) has garnered substantial interest among researchers and ophthalmologists due to its high promise as a potential treatment for infectious keratitis. The aim of this study is to evaluate the efficacy and safety of high fluence PACK-CXL, using 10.0 J/cm2 (30 mW/cm2, 5 min, and 33 s) at the slit lamp.Methods: This prospective interventional, nonrandomized cohort study included 20 eyes of 20 patients with bacterial, fungal, or mixed origin keratitis who underwent high fluence PACK-CXL treatment as an adjunct therapy to conventional antimicrobial therapy per American Academy of Ophthalmology treatment guidelines. The re-epithelization time was recorded, and corneal endothelial cell density was counted before and after treatment.Results: The average re-epithelization time was 8.2 ± 2.8 days (range 3–14 days). After PACK-CXL treatment, eight patients (40%) were directly discharged, while the remained patients stayed in the hospital for an average of 5.6 ± 3.5 days. No eyes required keratoplasty. Endothelial cell density counts before and after the PACK-CXL procedure were 2,562.1 ± 397.3, and 2,564.8 ± 404.5 cells/mm2, respectively (p = 0.96).Conclusion: although it was not a randomized control trial, we conclude that high fluence PACK-CXL as an adjuvant therapy is safe with no complications observed, and efficient as time to re-epithelization was less than 14 days for all patients and no patients underwent tectonic keratoplasties. Further research is needed to compare it to the current standard of care.

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Section: Introductionmentioning

confidence: 99%

Accelerated high fluence photoactivated chromophore for infectious keratitis—corneal cross-linking (PACK-CXL) at the slit lamp: a pilot study

Olshaker,

Achiron,

Chorny

et al. 2023

Front. Pharmacol.

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Collagen cross-linking as monotherapy in experimentally induced corneal abscess in rabbits

Saad,

Elnashar,

Negm

et al. 2023

BMC Ophthalmol

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Background and purpose Collagen cross-linking (CXL) has evolved as an essential therapeutic approach for corneal infections, allowing for rapidly eliminating the infecting microorganism while reducing inflammation. This study aims to evaluate the efficacy of CXL as a monotherapy for managing infectious keratitis caused by Fusarium solani and Pseudomonas aeruginosa. Materials and methods Forty-eight white New Zealand rabbits weighing approximately 1.5–2 KG were included. The cornea of one eye of each rabbit was inoculated with either Fusarium solani or Pseudomonas aeruginosa. Group A served as a control and was subdivided into two subgroups, A1 and A2; each subgroup consisted of 8 eyes and was injected with either Fusarium solani or Pseudomonas aeruginosa, respectively. Group B (16 eyes) was inoculated with Fusarium solani, while group C (16 eyes) were inoculated with Pseudomonas aeruginosa. All animals in Group B and C received CXL treatment one week after inoculation of the organisms and after corneal abscess formation was confirmed. At the same time, animals in Group A were left untreated. Results There was a statistically significant reduction in the number of colony-forming units (CFU) in Group B following CXL. No growth existed in any samples at the end of the 4th week. There was a statistically significant difference in the number of CFU between group B and the control group (p < 0.001). In group C, there was a statistically significant reduction in the CFU at the end of the first week after CXL. However, there was regrowth in all samples afterward. All 16 models in Group C showed uncountable and extensive growth during the subsequent follow-ups. There was no statistically significant difference between the number of CFU in Group C and the control group. Histopathology showed lesser corneal melting in CXL-treated Pseudomonas aeruginosa. Conclusions Collagen cross-linking is promising monotherapy and alternative treatment in managing infective keratitis caused by Fusarium solani but is less effective in Pseudomonas aeruginosa as monotherapy.

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How does atmospheric pressure cold helium plasma affect the biomechanical behaviour on alkali-lesioned corneas?

Neri,

Mascolini,

Peruffo

et al. 2024

BMC Vet Res

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Background Melting corneal ulcers are a serious condition that affects a great number of animals and people around the world and it is characterised by a progressive weakening of the tissue leading to possible severe ophthalmic complications, such as visual impairment or blindness. This disease is routinely treated with medical therapy and keratoplasty, and recently also with alternative regenerative therapies, such as cross-linking, amniotic membrane transplant, and laser. Plasma medicine is another recent example of regenerative treatment that showed promising results in reducing the microbial load of corneal tissue together with maintaining its cellular vitality. Since the effect of helium plasma application on corneal mechanical viscoelasticity has not yet been investigated, the aim of this study is first to evaluate it on ex vivo porcine corneas for different exposition times and then to compare the results with previous data on cross-linking treatment. Results 94 ex vivo porcine corneas divided into 16 populations (healthy or injured, fresh or cultured and treated or not with plasma or cross-linking) were analysed. For each population, a biomechanical analysis was performed by uniaxial stress-relaxation tests, and a statistical analysis was carried out considering the characteristic mechanical parameters. In terms of equilibrium normalised stress, no statistically significant difference resulted when the healthy corneas were compared with lesioned plasma-treated ones, independently of treatment time, contrary to what was obtained about the cross-linking treated corneas which exhibited more intense relaxation phenomena. Conclusions In this study, the influence of the Helium plasma treatment was observed on the viscoelasticity of porcine corneas ex vivo, by restoring in lesioned tissue a degree of relaxation similar to the one of the native tissue, even after only 2 min of application. Therefore, the obtained results suggest that plasma treatment is a promising new regenerative ophthalmic therapy for melting corneal ulcers, laying the groundwork for further studies to correlate the mechanical findings with corneal histology and ultrastructural anatomy after plasma treatment.

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Corneal cross-linking guards against infectious keratitis: an experimental model

Cited by 4 publications

References 52 publications

Accelerated high fluence photoactivated chromophore for infectious keratitis—corneal cross-linking (PACK-CXL) at the slit lamp: a pilot study

Accelerated high fluence photoactivated chromophore for infectious keratitis—corneal cross-linking (PACK-CXL) at the slit lamp: a pilot study

Collagen cross-linking as monotherapy in experimentally induced corneal abscess in rabbits

How does atmospheric pressure cold helium plasma affect the biomechanical behaviour on alkali-lesioned corneas?

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