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

Hagar Olshaker; Asaf Achiron; Alexander Chorny; Farhad Hafezi; Tal Yahalomi; Assaf Kratz; Erez Tsumi; Nan-Ji Lu; Boris Knyazer

doi:10.3389/fphar.2023.1229095

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

Front Pharmacol. 2023 Sep 7:14:1229095. doi: 10.3389/fphar.2023.1229095. eCollection 2023.

Authors

Hagar Olshaker¹, Asaf Achiron¹, Alexander Chorny², Farhad Hafezi^{3

4

5

6

7}, Tal Yahalomi⁸, Assaf Kratz², Erez Tsumi², Nan-Ji Lu⁴, Boris Knyazer²

Affiliations

¹ Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
² Department of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.
³ Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland.
⁴ ELZA Institute, Dietikon, Switzerland.
⁵ Faculty of Medicine, University of Geneva, Geneva, Switzerland.
⁶ Department of Ophthalmology, University of Southern California Roski Eye Institute, University of Southern California, Los Angeles, Los Angeles, CA, United States.
⁷ School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China.
⁸ Department of Ophthalmology, Samson Assuta Ashdod, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.

Abstract

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/cm² (30 mW/cm², 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/mm², 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.

Keywords: PACK-CXL; corneal cross-linking; high fluence; hypo-osmolar riboflavin; infectious keratitis; outcome.