Photo-activated chromophore for keratitis (PACK-CXL) window absorption (WA) alone versus combined PACK-CXL window absorption and standard anti-microbial therapy (SAT) for treatment of infectious keratitis: a prospective study

Abstract

Objective The aim of this study was to compare the outcome of photo-activated chromophore for keratitis cross-linking (PACK-CXL) window absorption (WA) alone with combined PACK-CXL WA and standard antimicrobial therapy (SAT) for treatment of infectious keratitis.Patients and methods This is a randomized prospective comparative clinical trial that enrolled 30 eyes with clinically suspected infectious keratitis. They were randomly assigned into 2 equal groups of 15 eyes each: Group A was treated by PACK-CXL WA alone and group B was treated by PACK-CXL WA combined with SAT. Identification of organisms was done by laboratory study before treatment. Corneal healing was evaluated by corneal examination and anterior segment OCT (AS-OCT).Results Complete healing and resolution (successful treatment) was observed in 10 eyes (66.7%) of group A and in 14 eyes (93.3%) of group B, a statistically significant difference (P=0.042). Complications were absent in 12 eyes (80%) in group A and in 14 eyes (93.3%) of group B. However, perforation and impending perforation were found in 3 patients of group A and in only 1 patient of group B, a statistically insignificant difference (P=0.123).Conclusion PACK-CXL is a promising, non-invasive treatment option for superficial infectious keratitis, especially when performed with WA technique, either alone or combined with SAT. However, combined PACK-CXL WA with SAT was more effective for treatment of infectious keratitis than PACK-CXL WA alone with shorter resolution period.