Intraoperative Photoactivated Chromophore for Infectious Keratitis-Corneal Cross-Linking (PACK-CXL) During Penetrating Keratoplasty for the Management of Fungal Keratitis in an Immunocompromised Patient

Dimitrios G Mikropoulos; George D Kymionis; Nafsika Voulgari; Eirini Kaisari; Konstantinos A Nikolakopoulos; Andreas Katsanos; Anastasios G Konstas

doi:10.1007/s40123-019-0196-4

Intraoperative Photoactivated Chromophore for Infectious Keratitis-Corneal Cross-Linking (PACK-CXL) During Penetrating Keratoplasty for the Management of Fungal Keratitis in an Immunocompromised Patient

Ophthalmol Ther. 2019 Sep;8(3):491-495. doi: 10.1007/s40123-019-0196-4. Epub 2019 Jul 5.

Authors

Dimitrios G Mikropoulos¹, George D Kymionis², Nafsika Voulgari², Eirini Kaisari², Konstantinos A Nikolakopoulos², Andreas Katsanos³, Anastasios G Konstas⁴

Affiliations

¹ 3rd University Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
² Ophthalmology Department, Jules Gonin Eye Hospital, University of Lausanne, Lausanne, Switzerland.
³ Department of Ophthalmology, University of Ioannina, Ioannina, Greece.
⁴ 1st and 3rd University, Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece. konstas@med.auth.gr.

Abstract

Introduction: To present a novel intraoperative application of photoactivated chromophore for infectious keratitis-corneal cross-linking (PACK-CXL) in the management of post-penetrating keratoplasty (PKP) multiresistant fungal keratitis in a patient with irradiation-related local immunosuppression.

Case report: A 62-year-old female underwent uneventful PKP for the management of post-irradiation actinic keratopathy. Three months postoperatively, she presented with a diffuse corneal melting abscess that was infiltrating the donor-recipient junction. Despite intensive antibiotic and antifungal therapy, corneal melting progressed to graft perforation. A repeat PKP combined with intraoperative PACK-CXL was performed. PACK-CXL was applied initially on the infected graft, involving the corneoscleral rim and then following placement of the donor button. No intra- or postoperative graft-related complications were encountered. No signs of infection were noted, and the graft remained clear during the 9-month follow-up period.

Conclusion: Intraoperative PACK-CXL combined with PKP appears to be a safe and effective technique for the management of post-PKP resistant fungal keratitis.

Keywords: Corneal cross-linking; Fungal keratitis; PACK-CXL; Penetrating keratoplasty.