title: UVA-riboflavin photochemical therapy of bacterial keratitis: a pilot study.
abstract: BACKGROUND
  The aim of this work as to investigate the photochemical interaction used in corneal crosslinking (CXL) as the primary therapy for bacterial keratitis.
  
  
  METHODS
  A prospective non-randomized study was conducted including 16 patients with a clinical diagnosis of bacterial keratitis. No patient had any prior antibiotic treatment for the current infection. Photography and microbial culturing of the infected cornea were performed. Riboflavin was topically administered for 20 min and ultraviolet light (UVA) exposure settings for treatment of keratoconus were used. After the procedure, clinical examinations were done at least once daily until signs of improvement had been established. The frequency of examinations was thereafter reduced. Antibiotic therapy was initiated if infectious progression was suspected. The trial was registered at ISCRTN.org (no: 21432643).
  
  
  RESULTS
  All eyes responded to the photochemical treatment with improvement in symptoms and signs of reduced inflammation. Epithelial healing was achieved in all cases. Antibiotic administration was necessary in two cases. One patient required a human amniotic membrane transplant.
  
  
  CONCLUSIONS
  This trial illustrates that photosensitization of riboflavin using UVA at 365 nm has the potential to induce healing in patients with microbial keratitis. The results from the treatment of these 16 patients with corneal ulcers indicate that UVA-riboflavin photochemical therapy merits a controlled study in order to assess its efficacy and safety compared to antibiotics.
authors.affiliation: Department of Ophthalmology, Örebro University Hospital, 701 85 Örebro, Sweden. karim.makdoumi@orebroll.se
authors.forename: Karim
authors.initials: K
authors.lastname: Makdoumi
authors.forename: Jes
authors.initials: J
authors.lastname: Mortensen
authors.forename: Omid
authors.initials: O
authors.lastname: Sorkhabi
authors.forename: Bo-Eric
authors.initials: BE
authors.lastname: Malmvall
authors.forename: Sven
authors.initials: S
authors.lastname: Crafoord
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000302:isolation & purification*; D003228:Conjunctiva / Q000382:microbiology; D003315:Cornea / Q000382:microbiology; D003320:Corneal Ulcer / Q000188:drug therapy* / Q000382:microbiology; D015818:Eye Infections, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D011446:Prospective Studies; D012256:Riboflavin / Q000627:therapeutic use*; D014466:Ultraviolet Rays; D014792:Visual Acuity / Q000502:physiology
chemical_list: D017319:Photosensitizing Agents; D012256:Riboflavin