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Merck
  • Collagen cross-linking with photoactivated riboflavin (PACK-CXL) for the treatment of advanced infectious keratitis with corneal melting.

Collagen cross-linking with photoactivated riboflavin (PACK-CXL) for the treatment of advanced infectious keratitis with corneal melting.

Ophthalmology (2014-03-01)
Dalia G Said, Mohamed S Elalfy, Zisis Gatzioufas, Ehab S El-Zakzouk, Mansour A Hassan, Mohamed Y Saif, Ahmed A Zaki, Harminder S Dua, Farhad Hafezi
ABSTRACT

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. Prospective clinical trial. Forty eyes from 40 patients with advanced infectious keratitis and coexisting corneal melting. 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. 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. 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. 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.

MATERIALS
Product Number
Brand
Product Description

Supelco
Riboflavin (B2), analytical standard
Riboflavin for peak identification, European Pharmacopoeia (EP) Reference Standard
Supelco
Riboflavin, Pharmaceutical Secondary Standard; Certified Reference Material
Sigma-Aldrich
(−)-Riboflavin, BioReagent, suitable for cell culture, suitable for insect cell culture, ≥98%
Sigma-Aldrich
(−)-Riboflavin, from Eremothecium ashbyii, ≥98%
Sigma-Aldrich
(−)-Riboflavin, meets USP testing specifications
Riboflavin, European Pharmacopoeia (EP) Reference Standard
USP
Riboflavin, United States Pharmacopeia (USP) Reference Standard