Photoactivated riboflavin treatment of infectious keratitis using collagen cross-linking technology.
OBJECTIVE
To evaluate riboflavin/ultraviolet-A (UVA) as an adjunct treatment for infectious keratitis.


METHODS
This prospective, dual-center, interventional case series included cases of infectious keratitis that were treated by instilling riboflavin 0.1% solution for 30 minutes to saturate the cornea, followed by exposure to 365-nm UVA light (3 mW/cm(2)) for 15 to 45 minutes, with continued instillation of riboflavin. Eyes continued on standard antibiotic treatment. The primary outcome measures were the times to resolution of the infiltrate and the epithelial defect.


RESULTS
Forty patients aged 14 to 86 years were enrolled. Seven (18%) eyes had a previous keratoplasty. Bacterial species were identified in 24 eyes, fungal in 7, protozoan in 2, viral in 1, and no organism in 6. The maximum infiltrate diameter ranged from 1 to 12 mm and the epithelial defect diameter was 0 to 8 mm before treatment. In 6 cases (2 bacterial, 3 fungal, and 1 without growth), the keratitis did not resolve successfully and the eye received a penetrating keratoplasty (PK). In 1 eye with prior PK, the infection resolved following treatment, but a regraft was required to address perforation of the PK incision.


CONCLUSIONS
Riboflavin/UVA should be avoided in eyes with prior herpes simplex but otherwise posed no obvious safety risk in this series and appeared to be most effective when the infection depth was limited. The success rate was higher for bacterial infections than fungal infections. Randomized studies against antibiotics alone are needed to further evaluate efficacy.
Cornea Research Foundation of America, Indianapolis, IN 46260, USA. mprice@cornea.org
Marianne O
MO
Price
Lawrence R
LR
Tenkman
Amilia
A
Schrier
Kelly M
KM
Fairchild
Stephen L
SL
Trokel
Francis W
FW
Price
D000048:Acanthamoeba / Q000302:isolation & purification; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000302:isolation & purification; D003094:Collagen / Q000378:metabolism*; D003319:Corneal Stroma / Q000378:metabolism; D003432:Cross-Linking Reagents / Q000627:therapeutic use*; D015817:Eye Infections / Q000188:drug therapy* / Q000378:metabolism / Q000382:microbiology / Q000469:parasitology; D005260:Female; D005658:Fungi / Q000302:isolation & purification; D006801:Humans; D007634:Keratitis / Q000188:drug therapy* / Q000378:metabolism / Q000382:microbiology / Q000469:parasitology; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D010865:Pilot Projects; D011446:Prospective Studies; D012256:Riboflavin / Q000627:therapeutic use*; D017211:Treatment Failure; D016896:Treatment Outcome; D014466:Ultraviolet Rays; D055815:Young Adult
D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin