Cornea on fire: PACK‐CXL in the treatment of infectious keratitis

Abstract

Infectious keratitis is a severe eye condition that can cause permanent vision loss if not treated promptly. The current standard of care for this condition involves the use of broad‐spectrum topical antibiotic drops. However, researchers have explored photoactivated chromophore for collagen cross‐linking (PACK‐CXL) as a potential treatment option for infectious keratitis. Studies have shown that PACK‐CXL can improve the healing process in bacterial keratitis and prevent corneal melting caused by bacterial enzymatic degradation.When activated by UV light, riboflavin, the photosensitizer used in PACK‐CXL, induces changes in collagen properties, leading to a hardening and strengthening effect on the corneal stroma. However, individuals with corneal ulcers may experience greater penetration of UV light due to the compromised integrity of the cornea, which could cause endothelial cell loss and impair corneal function.The purpose of this presentation is to provide a summary of the evidence on the comparative effectiveness and safety of PACK‐CXL with or without standard therapy versus standard therapy alone for the treatment of bacterial keratitis. The latest randomized controlled trials (RCTs) will be reviewed, and their findings regarding the efficacy and safety of PACK‐CXL in treating infectious keratitis will be discussed, as well as a comparison with standard antibiotic therapy alone. Ultimately, this talk aims to inform evidence‐based recommendations for the treatment of infectious keratitis and provide clinicians with the most up‐to‐date information to make informed treatment decisions.