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Sharma A, Sharma R, Chander J, Nirankari V. In vitro antimicrobial efficacy of riboflavin, ultraviolet-A radiation, and combined riboflavin/ultraviolet-A radiation on ocular pathogens. Taiwan J Ophthalmol 2023; 13:21-27. [DOI: 10.4103/tjo.tjo_28_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 06/14/2021] [Indexed: 03/14/2023] Open
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Abstract
BACKGROUND Infectious keratitis is an infection of the cornea that can be caused by bacteria, viruses, fungi, protozoa, or parasites. It may be associated with ocular surgery, trauma, contact lens wear, or conditions that cause deficiency or loss of corneal sensation, or suppression of the immune system, such as diabetes, chronic use of topical steroids, or immunomodulatory therapies. Photoactivated chromophore for collagen cross-linking (PACK-CXL) of the cornea is a therapy that has been successful in treating eye conditions such as keratoconus and corneal ectasia. More recently, PACK-CXL has been explored as a treatment option for infectious keratitis. OBJECTIVES To determine the comparative effectiveness and safety of PACK-CXL with standard therapy versus standard therapy alone for the treatment of bacterial keratitis. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2019, Issue 7); Ovid MEDLINE; Embase.com; PubMed; Latin American and Caribbean Health Science Information database (LILACS); ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We did not use any date or language restrictions in the electronic search for trials. We last searched the electronic databases on 8 July 2019. SELECTION CRITERIA We included randomized controlled trials (RCTs), quasi-RCTs, and controlled clinical trials (CCTs) of PACK-CXL for bacterial keratitis. We included quasi-RCTs and CCTs as we anticipated that there would not be many RCTs eligible for inclusion. DATA COLLECTION AND ANALYSIS Two review authors working independently selected studies for inclusion in the review, assessed trials for risk of bias, and extracted data. The primary outcome was proportion of participants with complete healing at four to eight weeks. Secondary outcomes included visual acuity, morphology, adverse events, and treatment failure at four to eight weeks. MAIN RESULTS We included three trials (two RCTs and one quasi-RCT) in this review for a total of 59 participants (59 eyes) with bacterial keratitis. Trials were all single-center and were conducted in Egypt, Iran, and Thailand between 2010 and 2014. It is very uncertain whether PACK-CXL with standard antibiotic therapy is more effective than standard antibiotic therapy alone for re-epithelialization and complete healing (risk ratio (RR) 1.53, 95% confidence interval (CI) 0.88 to 2.66; participants = 15). We judged the certainty of the evidence to be very low due to the small sample size and high risk of selection and performance bias. The high risk of selection bias reflects the overall review. Masking of participants was not possible for the surgical arm. No participant had a best-corrected visual acuity of 20/100 or better at eight weeks (very low certainty evidence). There is also no evidence that use of PACK-CXL with standard therapy results in fewer instances of treatment failure than standard therapy alone (RR 0.50, 95% CI 0.05 to 4.98; participants = 32). We judged the certainty of evidence to be low due to the small sample size and high risk of selection bias. There were no adverse events reported at 14 days (low certainty evidence). Data on other outcomes, such as visual acuity and morphological characteristics, could not be compared because of variable time points and specific metrics. AUTHORS' CONCLUSIONS The current evidence on the effectiveness of PACK-CXL for bacterial keratitis is of low certainty and clinically heterogenous in regard to outcomes. There are five ongoing RCTs enrolling 1136 participants that may provide better answers in the next update of this review. Any future research should include subgroup analyses based on etiology. A core outcomes set would benefit healthcare decision-makers in comparing and understanding study data.
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Affiliation(s)
- Shadi A Davis
- Ophthalmology and Ocuplastics Surgery, Cheyenne VA Hospital, Cheyenne, Wyoming, USA
| | - Renee Bovelle
- Department of Ophthalmology, Howard University, Washington, DC, USA
| | - Genie Han
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - John Kwagyan
- General Clinical Research Center, Howard University, Washington, DC, USA
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Khan NA, Anwar A, Siddiqui R. Acanthamoeba Keratitis: Current Status and Urgent Research Priorities. Curr Med Chem 2019; 26:5711-5726. [DOI: 10.2174/0929867325666180510125633] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/10/2018] [Accepted: 05/01/2018] [Indexed: 12/13/2022]
Abstract
Background:First discovered in the early 1970s, Acanthamoeba keratitis has remained a major eye infection and presents a significant threat to the public health, especially in developing countries. The aim is to present a timely review of our current understanding of the advances made in this field in a comprehensible manner and includes novel concepts and provides clear directions for immediate research priorities.Methods:We undertook a search of bibliographic databases for peer-reviewed research literature and also summarized our published results in this field.Results:The present review focuses on novel diagnostic and therapeutic strategies in details which can provide access to management and treatment of Acanthamoeba keratitis. This coupled with the recently available genome sequence information together with high throughput genomics technology and innovative approaches should stimulate interest in the rational design of preventative and therapeutic measures. Current treatment of Acanthamoeba keratitis is problematic and often leads to infection recurrence. Better understanding of diagnosis, pathogenesis, pathophysiology and therapeutic regimens, would lead to novel strategies in treatment and prophylaxis.
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Affiliation(s)
- Naveed Ahmed Khan
- Department of Biology, Chemistry and Environmental Sciences, College of Arts and Sciences, American University of Sharjah, University City, Sharjah, United Arab Emirates
| | - Ayaz Anwar
- Department of Biology, Chemistry and Environmental Sciences, College of Arts and Sciences, American University of Sharjah, University City, Sharjah, United Arab Emirates
| | - Ruqaiyyah Siddiqui
- Department of Biology, Chemistry and Environmental Sciences, College of Arts and Sciences, American University of Sharjah, University City, Sharjah, United Arab Emirates
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Gomart G, Denis J, Bourcier T, Dory A, Abou-Bacar A, Candolfi E, Sauer A. In Vitro Amoebicidal Activity of Titanium Dioxide/UV-A Combination AgainstAcanthamoeba. ACTA ACUST UNITED AC 2018; 59:4567-4571. [DOI: 10.1167/iovs.18-25003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Gabrielle Gomart
- Service d'Ophtalmologie, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
- Institut de Parasitologie et de Pathologie Tropicale de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Julie Denis
- Institut de Parasitologie et de Pathologie Tropicale de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Tristan Bourcier
- Service d'Ophtalmologie, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
- Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Anne Dory
- Service de Pharmacie, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Ahmed Abou-Bacar
- Institut de Parasitologie et de Pathologie Tropicale de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Ermanno Candolfi
- Institut de Parasitologie et de Pathologie Tropicale de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Arnaud Sauer
- Service d'Ophtalmologie, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
- Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
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Atia R, Jouve L, Knoeri J, Georgeon C, Laroche L, Borderie V, Bouheraoua N. [Corneal collagen cross-linking to treat infectious keratitis]. J Fr Ophtalmol 2018; 41:560-568. [PMID: 29903589 DOI: 10.1016/j.jfo.2017.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 12/06/2017] [Accepted: 12/07/2017] [Indexed: 11/24/2022]
Abstract
Infectious keratitis are a frequent cause of ocular morbidity. Today, new treatments are necessary to combat the emergence of antibiotic resistant germs. Corneal collagen cross-linking has been suggested to treat corneal infectious (PACK-CXL). Its action would be both antimicrobial and protective for the cornea, increasing its biochemical resistence to proteolytic enzymes. In vivo, PACK-CXL might demonstrate good efficacy against bacterial keratitis, contrary to herpetic keratitis for which it is contraindicated. For fungal or amoebic keratitis, results are uncertain regarding its safety and efficacy. The purpose of this paper is to clarify the use of corneal collagen cross-linking to treat infectious keratitis.
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Affiliation(s)
- R Atia
- Service d'ophtalmologie 5, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France
| | - L Jouve
- Service d'ophtalmologie 5, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France
| | - J Knoeri
- Service d'ophtalmologie 5, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France
| | - C Georgeon
- Service d'ophtalmologie 5, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France
| | - L Laroche
- Service d'ophtalmologie 5, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Inserm UMR S 968, université Pierre-et-Marie-Curie-Paris-VI, institut de la vision, 75012 Paris, France
| | - V Borderie
- Service d'ophtalmologie 5, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Inserm UMR S 968, université Pierre-et-Marie-Curie-Paris-VI, institut de la vision, 75012 Paris, France
| | - N Bouheraoua
- Service d'ophtalmologie 5, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Inserm UMR S 968, université Pierre-et-Marie-Curie-Paris-VI, institut de la vision, 75012 Paris, France.
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Ortillés Á, Belloc J, Rubio E, Fernández MT, Benito M, Cristóbal JÁ, Calvo B, Goñi P. In-vitro development of an effective treatment for Acanthamoeba keratitis. Int J Antimicrob Agents 2017; 50:325-333. [PMID: 28709990 DOI: 10.1016/j.ijantimicag.2017.03.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 03/07/2017] [Accepted: 03/11/2017] [Indexed: 10/19/2022]
Abstract
The aim of this study was to develop an in-vitro topical treatment for Acanthamoeba keratitis (AK) effective against cysts and trophozoites. Qualitative assays were performed with voriconazole, chlorhexidine, propamidine, cellulase, tobramycin, ciprofloxacin and paromomycin as monotherapy and various combinations. Riboflavin with ultraviolet-A (R + UV-A) as monotherapy or combined with voriconazole and moxifloxacin was also tested. Quantitative assays to assess cyst viability after treatment were performed for the chemicals that showed the highest activity in the qualitative assays. Paromomycin and propamidine did not show antiamoebic activity. Regardless of the total dose, no amoebicidal effect was observed for R + UV-A. Tobramycin, ciprofloxacin, voriconazole, chlorhexidine and cellulase were selected for quantitative assays because they appeared to cause greater damage to the structure of amoebae. Chlorhexidine and ciprofloxacin were the most active against Acanthamoeba spp. as monotherapy. Among the combinations evaluated, ciprofloxacin-voriconazole-chlorhexidine showed the greatest amoebicidal activity, with severe damage of the cellular membrane and an important decrease in cell concentration. In summary, ciprofloxacin as monotherapy and in combination with voriconazole and chlorhexidine has been classified as promising treatment. Additional in-vivo studies in animal models and clinical trials in patients with AK should be considered to confirm the efficacy of ciprofloxacin.
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Affiliation(s)
- Á Ortillés
- Aragón Institute of Engineering Research, University of Zaragoza, Zaragoza, Spain; Department of Animal Pathology, University of Zaragoza, Zaragoza, Spain.
| | - J Belloc
- Department of Microbiology, Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain
| | - E Rubio
- Department of Microbiology, Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain
| | - M T Fernández
- Department of Physiatry and Nursery, University of Zaragoza, Zaragoza, Spain
| | - M Benito
- Department of Microbiology, Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain
| | - J Á Cristóbal
- Department of Ophthalmology, 'Lozano Blesa' University Clinic Hospital, Zaragoza, Spain
| | - B Calvo
- Aragón Institute of Engineering Research, University of Zaragoza, Zaragoza, Spain; Bioengineering, Biomaterials and Nanomedicine Online Biomedical Research Centre, Madrid, Spain
| | - P Goñi
- Department of Microbiology, Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain
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Abstract
PURPOSE OF REVIEW New treatments for corneal ulcers are needed to address challenges with antibiotic resistance, cost, and specificity requiring timely pathogen identification. This review assesses the evidence regarding safety and efficacy of corneal cross-linking (CXL) as an adjunct or stand-alone treatment. RECENT FINDINGS To date approximately 200 clinical cases of CXL used with various types of infectious keratitis have been reported in about 30 publications. Most employed the CXL protocol developed for keratoconus as an adjunct to antibiotics for resistant ulcers, and a number of cases resolved after this intervention. However, a few studies raised concerns about resurgence and perforation when CXL was utilized with deep fungal infections. The infiltrate depth is an important consideration, because the standard CXL treatment is cytotoxic (to keratocytes) to a depth of approximately 200-300 μm and 50% of the energy is absorbed within the first 100 μm. CXL was used successfully as a monotherapy in approximately 16 eyes with early bacterial or shallow fungal infections. SUMMARY Further work is needed to develop optimized CXL protocols for treatment of corneal ulcers, define the appropriate conditions for use, and determine the safety and efficacy relative to standard antibiotic treatments.
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