CXL for

Infectious Keratitis

David Zadok, Yaakov Goldich, Isaac Avni

Department of Ophthalmology Assaf Harofeh Medical Center

Israel

The authors have no conflicts of interest and no financial interest in the article’s subject matter or methods mentioned.

The combined application of riboflavin and UV inactivates pathogens

– UV light alone has been shown to cause changes in

the nucleic acids of pathogens so they cannot replicate (oxygen radicals).

– Exposure to UV light activates the riboflavin in the complex and causes a chemical alteration to functional groups of the nucleic acids (primarily guanine bases), making pathogens unable to replicate

Case 1

• 21-year-old female

• Soft, color contact lenses,

otherwise healthy

• RE: few weeks painful red eye,

decreased vision, photophobia,

treated with dexamethasone and

chloramphenicol

• Signs: bulbar injection,

nonsuppurative ring infiltrate,

perineuritis

• Clinical presentation: m/p Acanthamoeba keratitis

• Samples were taken from the conjunctiva, cornea, and contact lens containers and fluids – negative

• Rx: PHMB,(Chlorhexidine), Brolene

• CXL – TCL, ofloxacin, dexamethasone

Case 1

Case 1

• Within a few days after the CXL treatment, the pain decreased, gradual reepithelization

• Two months after the treatment, the cornea was completely healed and the patient had no pain

Case 2

• 66-year-old female

• BE s/p PKP +Phaco+PC IOL (RE-2009 LE-2006)

• Dx: LE corneal abscess

• Laboratory workup – negative

• Rx: cefamezine + garamycin – worst

vancomycin + ceftazidime - worst

• CXL- TCL, dexamethasone, chloramphenicol

• Within a few days after the CXL treatment the abscess

healed

Case 3

• 42-year-old male

• BE s/p PKP (Keratoconus)(RE-2009, LE-2007), RGP CL

• Dx: LE corneal abscess

• Eye culture- Serratia marcescens

• Rx: moxifloxacin – worst, cefamezine + garamycin - worst, vancomycin + ceftazidime - worst

Case 3

• CXL – TCL, dexamethasone, garamycin, cefamezine

• Corneal melting – doxycyline

• LE PKP – replacing melted corneal button

Case 3

Summery

• UVA-riboflavin crosslinking can be useful for the treatment of corneal abscesses unresponsive to medical treatment

Thank You