Efficacy of Primary Collagen Cross-Linking with Photoactivated Chromophore (PACK-CXL) for the Treatment of Staphylococcus aureus–Induced Corneal Ulcers

Tal, Kfir; Gal-Or, Orly; Pillar, Shani; Zahavi, Alon; Rock, Oded; Bahar, Irit

doi:10.1097/ico.0000000000000550

Cited by 22 publications

(16 citation statements)

References 27 publications

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“…As microbial resistance to antibiotics increases, new lines of treatment will be needed and thus CXL may be a promising alternative or adjunct to current therapy. Both a recent animal study [84] using S. aureus induced ulcers in the rabbit as a model and a study involving 32 patients with moderate bacterial corneal ulcers [85] provide positive data to support this tenet. In fact, in the patient study, CXL treatment accelerated epithelial healing and shortened treatment time.…”

Section: New Frontiers In Treatmentmentioning

confidence: 93%

Challenges of corneal infections

Hazlett

Suvas

McClellan

et al. 2016

Expert Review of Ophthalmology

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Introduction Ocular infections remain an important cause of blindness worldwide and represent a challenging public health concern. In this regard, microbial keratitis due to fungal, bacterial, or viral infection can result in significant vision loss secondary to corneal scarring or surface irregularity. Left untreated corneal perforation and endophthalmitis can result, leading to loss of the eye. Rigorously studied animal models of disease pathogenesis have provided novel information that suggests new modes of treatment that may be efficacious clinically and emerging clinical data is supportive of some of these discoveries. Areas covered This review focuses on advances in our understanding of disease pathogenesis in animal models and clinical studies and how these relate to improved clinical treatment. We also discuss a novel approach to treatment of microbial keratitis due to infection with these bacterial pathogens using PACK-CXL and recommend increased basic and clinical studies to address and refine the efficacy of this procedure. Expert commentary Because resistance to antibiotics has developed over time to these bacterial pathogens, caution must be exercised in treatment. Attractive novel modes of treatment that hold new promise for further investigation include lipid based therapy, as well as use of small molecules that bind deleterious specific host responsive molecules and use of microRNA based therapies.

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Section: New Frontiers In Treatmentmentioning

confidence: 93%

Challenges of corneal infections

Hazlett

Suvas

McClellan

et al. 2016

Expert Review of Ophthalmology

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“…evaluated the efficacy of corneal CXL as primary therapy for S. aureus corneal ulcer in rabbit model. [22] Forty rabbits were randomly assigned to four groups: group-A: No treatment (control); Group-B: Topical antibiotic treatment (cefazolin 50 mg/mL, Garamycin 14 mg/mL drops, and chloramphenicol 5% ointment every 2 h); Group-C: CXL; and Group-D: CXL + topical antibiotics. After 1 month of treatment, Group-C ulcers had the smallest mean scar diameter and shortest mean healing time.…”

Section: Are These Results Translated In In Iivo Animal Experiments?mentioning

confidence: 99%

Collagen cross-linking for microbial keratitis

Garg

Das

Roy

2017

Middle East Afr J Ophthalmol

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“…Despite numerous clinical reports with promising results after use of PACK‐CXL, there are few controlled trials regarding the outcome of CXL treatment compared to antibiotic treatment alone for infectious keratitis . CXL research in animals has mainly been performed experimentally, Tal et al compared CXL treatment alone, medical treatment alone, CXL + topical antibiotics to no treatment in rabbits with corneal ulcers infected with Staphylococcus aureus. The authors concluded that CXL had a positive effect both as stand‐alone treatment and in combination with medical therapy.…”

Section: Discussionmentioning

confidence: 99%

Corneal cross‐linking (CXL)—A clinical study to evaluate CXL as a treatment in comparison with medical treatment for ulcerative keratitis in horses

Edman

Ström

Ekesten

2019

Veterinary Ophthalmology

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Objective Compare CXL treatment with medical treatment alone in horses with stromal, ulcerative keratitis. Animals studied: 24 horses (24 eyes) with stromal, ulcerative keratitis were included. Procedure 12 horses were initially treated with CXL, and 12 horses were given conventional medical treatment. Topical medical treatment was added to horses in the CXL group if necessary. Parameters including cytology, microbial growth, time to fluorescein negativity, and time to inhibition of stromal melting were evaluated. Results After the first day of treatments, a decrease in inflammatory signs and pain from the eye was observed in both groups. Stromal melting ceased within 24 hours regardless of treatment. CXL treatment alone was sufficient in 3 horses with noninfectious, superficial stromal ulcerations. Clinical signs of impaired wound healing were seen after 3‐14 days in corneas with suspected or proven bacterial infection treated with CXL only, most likely because of insufficient elimination of bacteria deeper in the corneal stroma or because of re‐infection from bacteria in the conjunctiva. The average decrease in stromal ulcer area per day after onset of treatment was almost identical between the groups, and no significant difference in time to fluorescein negativity was found. Conclusions We consider CXL a possible useful adjunct treatment of corneal stromal ulcers in horses, especially for melting ulcers and as a potential alternative to prophylactic antibiotic treatment for noninfected stromal ulcers. However, CXL should not be used alone for infected or suspected infected stromal ulcers, because topical antibiotics were required in all horses with proven infectious keratitis.

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Efficacy of Primary Collagen Cross-Linking with Photoactivated Chromophore (PACK-CXL) for the Treatment of Staphylococcus aureus–Induced Corneal Ulcers

Abstract: We demonstrate a beneficial effect of PACK-CXL as primary treatment, either as stand-alone or as an adjuvant to antimicrobial therapy.

Cited by 22 publications

References 27 publications

Challenges of corneal infections

Challenges of corneal infections

Collagen cross-linking for microbial keratitis

Corneal cross‐linking (CXL)—A clinical study to evaluate CXL as a treatment in comparison with medical treatment for ulcerative keratitis in horses

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