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Accelerated high fluence photoactivated chromophore for infectious keratitis—corneal cross-linking (PACK-CXL) at the slit lamp: a pilot study

Affiliation
Tel Aviv Sourasky Medical Center ,Sackler School of Medicine ,Tel Aviv University ,Tel Aviv ,Israel
Olshaker, Hagar;
Affiliation
Tel Aviv Sourasky Medical Center ,Sackler School of Medicine ,Tel Aviv University ,Tel Aviv ,Israel
Achiron, Asaf;
Affiliation
Department of Ophthalmology ,Soroka University Medical Center ,Faculty of Health Sciences ,Ben-Gurion University of the Negev ,Be’er Sheva ,Israel
Chorny, Alexander;
Affiliation
Center for Applied Biotechnology and Molecular Medicine (CABMM) ,University of Zurich ,Zurich ,Switzerland
Hafezi, Farhad;
Affiliation
Department of Ophthalmology ,Samson Assuta Ashdod ,Faculty of Health Sciences ,Ben-Gurion University of the Negev ,Be’er Sheva ,Israel
Yahalomi, Tal;
Affiliation
Department of Ophthalmology ,Soroka University Medical Center ,Faculty of Health Sciences ,Ben-Gurion University of the Negev ,Be’er Sheva ,Israel
Kratz, Assaf;
Affiliation
Department of Ophthalmology ,Soroka University Medical Center ,Faculty of Health Sciences ,Ben-Gurion University of the Negev ,Be’er Sheva ,Israel
Tsumi, Erez;
Affiliation
ELZA Institute ,Dietikon ,Switzerland
Lu, Nan-Ji;
Affiliation
Department of Ophthalmology ,Soroka University Medical Center ,Faculty of Health Sciences ,Ben-Gurion University of the Negev ,Be’er Sheva ,Israel
Knyazer, Boris

Introduction: Photoactivated Chromophore for Infectious Keratitis-Corneal Cross-Linking (PACK-CXL) has garnered substantial interest among researchers and ophthalmologists due to its high promise as a potential treatment for infectious keratitis. The aim of this study is to evaluate the efficacy and safety of high fluence PACK-CXL, using 10.0 J/cm 2 (30 mW/cm 2 , 5 min, and 33 s) at the slit lamp. Methods: This prospective interventional, nonrandomized cohort study included 20 eyes of 20 patients with bacterial, fungal, or mixed origin keratitis who underwent high fluence PACK-CXL treatment as an adjunct therapy to conventional antimicrobial therapy per American Academy of Ophthalmology treatment guidelines. The re-epithelization time was recorded, and corneal endothelial cell density was counted before and after treatment. Results: The average re-epithelization time was 8.2 ± 2.8 days (range 3–14 days). After PACK-CXL treatment, eight patients (40%) were directly discharged, while the remained patients stayed in the hospital for an average of 5.6 ± 3.5 days. No eyes required keratoplasty. Endothelial cell density counts before and after the PACK-CXL procedure were 2,562.1 ± 397.3, and 2,564.8 ± 404.5 cells/mm 2 , respectively ( p = 0.96). Conclusion: although it was not a randomized control trial, we conclude that high fluence PACK-CXL as an adjuvant therapy is safe with no complications observed, and efficient as time to re-epithelization was less than 14 days for all patients and no patients underwent tectonic keratoplasties. Further research is needed to compare it to the current standard of care.

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License Holder: Copyright © 2023 Olshaker, Achiron, Chorny, Hafezi, Yahalomi, Kratz, Tsumi, Lu and Knyazer.

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