title: Collagen cross-linking with photoactivated riboflavin (PACK-CXL) for the treatment of advanced infectious keratitis with corneal melting.
abstract: OBJECTIVE
  To investigate the efficacy and safety of corneal collagen cross-linking (CXL) with photoactivated riboflavin (photoactivated chromophore for infectious keratitis [PACK]-CXL) in the management of infectious keratitis with corneal melting.
  
  
  METHODS
  Prospective clinical trial.
  
  
  METHODS
  Forty eyes from 40 patients with advanced infectious keratitis and coexisting corneal melting.
  
  
  METHODS
  Twenty-one patients (21 eyes) underwent PACK-CXL treatment in addition to antimicrobial therapy. The control group consisted of 19 patients (19 eyes) who received only antimicrobial therapy.
  
  
  METHODS
  The slit-lamp characteristics of the corneal ulceration, corrected distance visual acuity, duration until healing, and complications were documented in each group. The Mann-Whitney U test was used for statistical analysis. P values less than 0.05 were considered statistically significant.
  
  
  RESULTS
  The average time until healing was 39.76 ± 18.22 days in the PACK-CXL group and 46.05 ± 27.44 days in the control group (P = 0.68). After treatment and healing, corrected distance visual acuity was 1.64 ± 0.62 in the PACK-CXL group and 1.67 ± 0.48 in the control group (P = 0.68). The corneal ulceration's width and length was significantly bigger in the PACK-CXL group (P = 0.004 and P = 0.007). Three patients in the control group demonstrated corneal perforation; infection recurred in 1 of them. No serious complications occurred in the PACK-CXL group.
  
  
  CONCLUSIONS
  Corneal CXL with photoactivated riboflavin did not shorten the time to corneal healing; however, the complication rate was 21% in the control group, whereas there was no incidence of corneal perforation or recurrence of the infection in the PACK-CXL group. These results indicate that PACK-CXL may be an effective adjuvant therapy in the management of severe infectious keratitis associated with corneal melting.
authors.affiliation: Research Institute of Ophthalmology, Cairo, Egypt.
authors.forename: Dalia G
authors.initials: DG
authors.lastname: Said
authors.affiliation: Research Institute of Ophthalmology, Cairo, Egypt.
authors.forename: Mohamed S
authors.initials: MS
authors.lastname: Elalfy
authors.affiliation: Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Zisis
authors.initials: Z
authors.lastname: Gatzioufas
authors.affiliation: Research Institute of Ophthalmology, Cairo, Egypt.
authors.forename: Ehab S
authors.initials: ES
authors.lastname: El-Zakzouk
authors.affiliation: Department of Ophthalmology, Beni-Suef University Hospitals, Cairo, Egypt.
authors.forename: Mansour A
authors.initials: MA
authors.lastname: Hassan
authors.affiliation: Department of Ophthalmology, Beni-Suef University Hospitals, Cairo, Egypt.
authors.forename: Mohamed Y
authors.initials: MY
authors.lastname: Saif
authors.affiliation: Research Institute of Ophthalmology, Cairo, Egypt.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Zaki
authors.affiliation: Department of Ophthalmology and Visual Sciences, Nottingham University Hospitals, Nottingham, United Kingdom.
authors.forename: Harminder S
authors.initials: HS
authors.lastname: Dua
authors.affiliation: Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland; Doheny Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California. Electronic address: farhad@hafezi.ch.
authors.forename: Farhad
authors.initials: F
authors.lastname: Hafezi
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003094:Collagen / Q000378:metabolism*; D003319:Corneal Stroma / Q000378:metabolism; D003320:Corneal Ulcer / Q000188:drug therapy* / Q000378:metabolism / Q000382:microbiology; D003432:Cross-Linking Reagents / Q000627:therapeutic use*; D015817:Eye Infections / Q000188:drug therapy* / Q000378:metabolism / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D011446:Prospective Studies; D012256:Riboflavin / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D014466:Ultraviolet Rays; D014792:Visual Acuity / Q000502:physiology
chemical_list: D000900:Anti-Bacterial Agents; D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin