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PACK-CXL: Corneal cross-linking in infectious keratitis.

Tabibian D, Mazzotta C, Hafezi F - Eye Vis (Lond) (2016)

Bottom Line: 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).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.

View Article: PubMed Central - PubMed

Affiliation: Laboratory for Ocular Cell Biology, University of Geneva, Geneva, Switzerland ; Department of Ophthalmology, Northampton General Hospital, Northampton, United Kingdom.

ABSTRACT

Background: Corneal 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.

Review: Ultraviolet-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).

Conclusion: PACK-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.

No MeSH data available.


Related in: MedlinePlus

Pre- and post-treatment peripheral infectious keratitis. a Anterior segment photography of a patient with early peripheral infectious keratitis (arrow). b Anterior segment OCT of the lesion. c Anterior segment photography of the same patient 7 days after PACK-CXL (9 mW/cm2 irradiance for 10 min) with resolution of the peripheral infectious keratitis (arrow). d Anterior segment OCT of the lesion at day 7 after PACK-CXL
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Fig1: Pre- and post-treatment peripheral infectious keratitis. a Anterior segment photography of a patient with early peripheral infectious keratitis (arrow). b Anterior segment OCT of the lesion. c Anterior segment photography of the same patient 7 days after PACK-CXL (9 mW/cm2 irradiance for 10 min) with resolution of the peripheral infectious keratitis (arrow). d Anterior segment OCT of the lesion at day 7 after PACK-CXL

Mentions: The management of corneal ectatic disorder was completely transformed this past decade through the development and rise of the corneal cross-linking (CXL) technique in many academic and non-academic clinical settings around the world. Originally developed in Europe, more precisely in Germany and Switzerland, CXL proposed a new therapeutic alternative to patients with progressive keratoconus with the option of stabilizing the disease through a one-time extra-ocular surgical treatment [1, 2]. Easy to perform and efficient after one treatment, this technique became the benchmark for the treatment of progressive keratoconus. With this initial success, the technique was later adapted to treat iatrogenic corneal ectatic disorders [3, 4], bullous keratopathy [5, 6], and melting corneal ulcerations [7]. Initially, only advanced cases of corneal keratitis were treated, but more recently, beginning infections are also responding positively to CXL (Fig. 1, a-d). The number of publications reporting successful treatment of infectious keratitis with CXL is increasing. CXL could become a new alternative to standard treatment of infectious keratitis in the future.Fig. 1


PACK-CXL: Corneal cross-linking in infectious keratitis.

Tabibian D, Mazzotta C, Hafezi F - Eye Vis (Lond) (2016)

Pre- and post-treatment peripheral infectious keratitis. a Anterior segment photography of a patient with early peripheral infectious keratitis (arrow). b Anterior segment OCT of the lesion. c Anterior segment photography of the same patient 7 days after PACK-CXL (9 mW/cm2 irradiance for 10 min) with resolution of the peripheral infectious keratitis (arrow). d Anterior segment OCT of the lesion at day 7 after PACK-CXL
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4836155&req=5

Fig1: Pre- and post-treatment peripheral infectious keratitis. a Anterior segment photography of a patient with early peripheral infectious keratitis (arrow). b Anterior segment OCT of the lesion. c Anterior segment photography of the same patient 7 days after PACK-CXL (9 mW/cm2 irradiance for 10 min) with resolution of the peripheral infectious keratitis (arrow). d Anterior segment OCT of the lesion at day 7 after PACK-CXL
Mentions: The management of corneal ectatic disorder was completely transformed this past decade through the development and rise of the corneal cross-linking (CXL) technique in many academic and non-academic clinical settings around the world. Originally developed in Europe, more precisely in Germany and Switzerland, CXL proposed a new therapeutic alternative to patients with progressive keratoconus with the option of stabilizing the disease through a one-time extra-ocular surgical treatment [1, 2]. Easy to perform and efficient after one treatment, this technique became the benchmark for the treatment of progressive keratoconus. With this initial success, the technique was later adapted to treat iatrogenic corneal ectatic disorders [3, 4], bullous keratopathy [5, 6], and melting corneal ulcerations [7]. Initially, only advanced cases of corneal keratitis were treated, but more recently, beginning infections are also responding positively to CXL (Fig. 1, a-d). The number of publications reporting successful treatment of infectious keratitis with CXL is increasing. CXL could become a new alternative to standard treatment of infectious keratitis in the future.Fig. 1

Bottom Line: 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).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.

View Article: PubMed Central - PubMed

Affiliation: Laboratory for Ocular Cell Biology, University of Geneva, Geneva, Switzerland ; Department of Ophthalmology, Northampton General Hospital, Northampton, United Kingdom.

ABSTRACT

Background: Corneal 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.

Review: Ultraviolet-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).

Conclusion: PACK-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.

No MeSH data available.


Related in: MedlinePlus