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document
Collagen cross-linking with photoactivated riboflavin ( PACK-CXL ) for the treatment of advanced infectious keratitis with corneal melting . PURPOSE To investigate the efficacy and safety of corneal collagen cross-linking ( CXL ) with photoactivated riboflavin ( photoactivated chromophore for infectious keratitis [ PACK ] -CXL ) in the management of infectious keratitis with corneal melting . DESIGN Prospective clinical trial . PARTICIPANTS Forty eyes from 40 patients with advanced infectious keratitis and coexisting corneal melting . METHODS Twenty-one patients ( 21 eyes ) underwent PACK-CXL treatment in addition to antimicrobial therapy . The control group consisted of 19 patients ( 19 eyes ) who received only antimicrobial therapy . MAIN OUTCOME MEASURES The slit-lamp characteristics of the corneal ulceration , corrected distance visual acuity , duration until healing , and complications were documented in each group . The Mann-Whitney U test was used for statistical analysis . P values less than 0.05 were considered statistically significant . RESULTS The average time until healing was 39.76 ± 18.22 days in the PACK-CXL group and 46.05 ± 27.44 days in the control group ( P = 0.68 ) . After treatment and healing , corrected distance visual acuity was 1.64 ± 0.62 in the PACK-CXL group and 1.67 ± 0.48 in the control group ( P = 0.68 ) . The corneal ulceration 's width and length was significantly bigger in the PACK-CXL group ( P = 0.004 and P = 0.007 ) . Three patients in the control group demonstrated corneal perforation ; infection recurred in 1 of them . No serious complications occurred in the PACK-CXL group . CONCLUSIONS Corneal CXL with photoactivated riboflavin did not shorten the time to corneal healing ; however , the complication rate was 21 % in the control group , whereas there was no incidence of corneal perforation or recurrence of the infection in the PACK-CXL group . These results indicate that PACK-CXL may be an effective adjuvant therapy in the management of severe infectious keratitis associated with corneal melting .
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Intervention_Pharmacological
Collagen cross-linking with photoactivated riboflavin ( PACK-CXL )
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Intervention_Pharmacological
corneal collagen cross-linking ( CXL )
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Intervention_Pharmacological
photoactivated riboflavin ( photoactivated chromophore for infectious keratitis [ PACK ] -CXL )
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Intervention_Pharmacological
PACK-CXL treatment in addition to antimicrobial therapy .
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Intervention_Pharmacological
only antimicrobial therapy
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Outcome_Other
efficacy and safety
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Outcome_Physical
slit-lamp characteristics of the corneal ulceration
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Outcome_Physical
corrected distance visual acuity
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Outcome_Physical
duration until healing
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Outcome_Physical
complications
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Outcome_Physical
time until healing
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Participant_Sample-size
40
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Participant_Condition
advanced infectious keratitis and coexisting corneal melting
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Participant_Sample-size
Twenty-one patients
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Participant_Sample-size
The control group consisted of 19 patients