Riboflavin/ultravoilet light-mediated crosslinking for fungal keratitis

Li, Zhiwei; Jhanji, Vishal; Tao, Xiangchen; Yu, Hong-Min; Chen, Wei; Mu, Guoying

doi:10.1136/bjophthalmol-2012-302518

Cited by 82 publications

(55 citation statements)

References 6 publications

(6 reference statements)

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“…Corneal collagen cross-linking (CXL) is a relatively new technique currently been investigated in conjunction with photo-activated riboflavin (PAR) in refractory keratitis cases [102,137]. Investigations into the use of nanoparticle technology with terbinafine and silver have also shown promising results [189,214].…”

Section: Treatmentmentioning

confidence: 99%

Pathogenesis of microbial keratitis

Lakhundi

Siddiqui

Khan

2017

Microbial Pathogenesis

171

121

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Microbial keratitis is a sight-threatening ocular infection caused by bacteria, fungi, and protist pathogens. Epithelial defects and injuries are key predisposing factors making the eye susceptible to corneal pathogens. Among bacterial pathogens, the most common agents responsible for keratitis include Staphylococcus aureus, Pseudomonas aeruginosa, Streptococcus pneumonia and Serratia species. Fungal agents of corneal infections include both filamentous as well as yeast, including Fusarium, Aspergillus, Phaeohyphomycetes, Curvularia, Paecilomyces, Scedosporium and Candida species, while in protists, Acanthamoeba spp. are responsible for causing ocular disease. Clinical features include redness, pain, tearing, blur vision and inflammation but symptoms vary depending on the causative agent. The underlying molecular mechanisms associated with microbial pathogenesis include virulence factors as well as the host factors that aid in the progression of keratitis, resulting in damage to the ocular tissue. The treatment therefore should focus not only on the elimination of the culprit but also on the neutralization of virulence factors to minimize the damage, in addition to repairing the damaged tissue. A complete understanding of the pathogenesis of microbial keratitis will lead to the rational development of therapeutic interventions. This is a timely review of our current understanding of the advances made in this field in a comprehensible manner. Coupled with the recently available genome sequence information and high throughput genomics technology, and the availability of innovative approaches, this will stimulate interest in this field.

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Section: Treatmentmentioning

confidence: 99%

Pathogenesis of microbial keratitis

Lakhundi

Siddiqui

Khan

2017

Microbial Pathogenesis

171

121

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“…[9][10][11] The mechanisms of stopping the infectious and inflammatory processes in keratitis cases might include multiple synergistic effects, in addition to the inactivation of pathogens. It is known that enzymatic digestion is 1 of the mechanisms used by pathogens in infectious corneal melting.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 Corneal collagen cross-linking (CXL) using ultraviolet A and riboflavin is a treatment that was previously developed to increase the biomechanical strength of the cornea in keratoconus. 9 The antibacterial effect of the ultraviolet A and riboflavin combination was demonstrated by illumination of agar plates in the presence of riboflavin, which induced efficient growth inhibition of different bacteria. Numerous case reports have shown the effect of CXL in refractory infectious keratitis.…”

Section: Introductionmentioning

confidence: 99%

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Yağcı

Palamar²,

S³

et al. 2016

Exp Clin Transplant

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Objectives: To report a case of Acremonium keratitis treated with voriconazole, corneal collagen crosslinking, and corneal transplant. Materials and Methods: Case report. Results: A 42-year-old woman who wore contact lenses daily was referred for refractory keratitis. Her main complaints were gritty sensation and pain. At slit lamp biomicroscopy, an infiltrate on the inferior paracentral cornea and an arcuate conjunctival ulceration were evident. The rest of the cornea was clear with no anterior chamber reaction. Scrapings from the corneal ulcer showed Candida parapsilosis and Acremonium species, which were sensitive to voriconazole. Despite the administration of topical, systemic, and intrastromal voriconazole for 1 month, repeat corneal scraping was positive for Acremonium, and clinical appearance and pain did not resolve. Therefore, corneal collagen cross-linking was applied. Although the pain resolved immediately after the procedure, the lesion showed no improvement. After a month of cross-linking, corneal transplant was performed for visual rehabilitation and treatment of the refractory lesion. The excised corneal button was negative for any microorganisms. Conclusions: Although corneal collagen cross-linking may be an effective treatment for Acremonium keratitis refractory to medical therapy, corneal transplant was required for visual gain and recovery.

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“…As enzymatic degradation of corneal integrity occurs in infectious keratitis, CXL with PAR has been investigated in refractory cases (bacterial, acnathamoebal, as well as fungal) [61][62][63]. In an in vitro study on CXL/PAR treatment of C. albicans and F. solani, phenotypic changes were noted on growth plates for both fungal agents, but no difference was noted by cell counter analysis of morphology between untreated fungal elements and those treated [64 • ].…”

Section: Methodsmentioning

confidence: 99%

Fungal Keratitis: Update for 2014

Stone

Tan

2014

Curr Ophthalmol Rep

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Fungal keratitis is a challenging problem worldwide, and many obstacles remain to the effective prevention, diagnosis, and therapy of this vision-threatening condition. Recent research has highlighted progress in each of these facets of the clinical approach to keratomycosis. Increased awareness of contact lens-associated fungal keratitis has prompted regulators to pay greater attention to testing of contact lens solutions under realworld conditions. Related research has also delved into the mechanisms of fungal biofilm formation and related therapeutic targets. Advances in polymerase chain reaction methodologies promise to increase the rapidity and accuracy of diagnosis, thereby decreasing the delay in instituting appropriate therapy. Antifungal pharmacologic agents remain the first line of therapy, with the newer azole antifungal voriconazole being utilized in innovative ways, such as via intrastromal injection. Large prospective studies such as the Mycotic Ulcer Treatment Trial have helped delineate optimal treatment algorithms, and variations in surgical techniques and postoperative regimens continue to be refined. Natamycin may still be more effective than other recently utilized antifungals for the treatment of Fusarium infections, but treatment failure is still a concern. Post-keratoplasty immunosuppression may benefit from the use of topical calcineurin inhibitors such as cyclosporine and tacrolimus, given their intrinsic antifungal properties. It can be argued that the prevention, diagnosis, and treatment of fungal keratitis lag behind the state of the art for bacterial keratitis, but dramatic improvements are undoubtedly on the horizon.

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Riboflavin/ultravoilet light-mediated crosslinking for fungal keratitis

Cited by 82 publications

References 6 publications

Pathogenesis of microbial keratitis

Pathogenesis of microbial keratitis

Untitled

Fungal Keratitis: Update for 2014

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