Current and Future Applications of Photoactivated Chromophore for Keratitis-Corneal Collagen Cross-Linking (PACK-CXL): An Overview of the Different Treatments Proposed.
OBJECTIVE
To review the application of the PACK-CXL and to identify different treatment protocols according to the pathogens associated with keratitis.


METHODS
A systematic review of 21 articles. The primary outcome was the healing of a corneal ulcer, defined as epithelization, blocking corneal melting. The secondary end-point was the recovery of visual acuity.


RESULTS
We studied a total of 145 eyes. Infectious keratitis was associated with bacteria in 80 eyes (55.55%), fungus in 24 eyes (16.67%), and protozoa in 13 (8.97%). In 26 (18%), the microbiological culture was negative or not performed. The mean time of re-epithelization was 25.70±29.83days (1-180). A total of 27 patients needed corneal transplantation. The overall probability of blocking corneal melting was 84.13%. Three different protocols for each group of pathogens have been proposed.


CONCLUSIONS
PACK-CXL still has a limit in its spread. In the future, we hope that each pathogen will be treated with the most efficient and least invasive protocols available.
a Department of Ophthalmology , University of Rome , Rome , Italy.
A
A
Abbouda
a Department of Ophthalmology , University of Rome , Rome , Italy.
I
I
Abicca
b Vissum Corporacion Oftalmologica , Alicante , Spain.
J L
JL
Alió
D016039:Corneal Transplantation / Q000706:statistics & numerical data; D003432:Cross-Linking Reagents / Q000627:therapeutic use; D015818:Eye Infections, Bacterial / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D007634:Keratitis / Q000188:drug therapy* / Q000382:microbiology; D010778:Photochemotherapy / Q000379:methods* / Q000639:trends; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D012256:Riboflavin / Q000627:therapeutic use; D014466:Ultraviolet Rays; D014792:Visual Acuity
D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D012256:Riboflavin
AS-OCT; UVA; infectious keratitis; melting; re-epithelization; riboflavin