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Awad R, Ghaith AA, Awad K, Mamdouh Saad M, Elmassry AA. Fungal Keratitis: Diagnosis, Management, and Recent Advances. Clin Ophthalmol 2024; 18:85-106. [PMID: 38223815 PMCID: PMC10788054 DOI: 10.2147/opth.s447138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/09/2023] [Indexed: 01/16/2024] Open
Abstract
Fungal keratitis is one of the major causes of microbial keratitis that may lead to corneal blindness. Many problems related to diagnosis and therapy are encountered in fungal keratitis, including difficulty in obtaining laboratory diagnoses and the availability and efficacy of antifungal medications. Intensive and prolonged use of antifungal topical preparations may not be enough. The use of antifungal medications is considered the main treatment for fungal keratitis. It is recommended to start antifungal therapy after confirmation of the clinical diagnosis with a smear or positive cultures. Topical application of antifungal medications is a mainstay for the treatment of fungal keratitis; however, systemic, intra-stromal, or intra-cameral routes may be used. Therapeutic keratoplasty is the main surgical procedure approved for the management of fungal keratitis with good success rate. Intrastromal corneal injection of antifungal medications may result in steady-state drug levels within the corneal tissue and prevent intervals of decreased antifungal drug concentration below its therapeutic level. In cases of severe fungal keratitis with deep stromal infiltration not responding to treatment, intracameral injection of antifungal agents may be effective. Collagen cross-linking has been proposed to be beneficial for cases of fungal keratitis as a stand-alone therapy or as an adjunct to antifungal medications. Although collagen cross-linking has been extensively studied in the past few years, its protocol still needs many modifications to optimize UV fluence levels, irradiation time, and concentration of riboflavin to achieve 100% microbial killing.
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Affiliation(s)
- Ramy Awad
- Department of Ophthalmology, Alexandria General Ophthalmology Hospital, Alexandria, Egypt
| | - Alaa Atef Ghaith
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Khaled Awad
- Department of Ophthalmology, Alexandria General Ophthalmology Hospital, Alexandria, Egypt
| | - Marina Mamdouh Saad
- Department of Ophthalmology, Alexandria General Ophthalmology Hospital, Alexandria, Egypt
| | - Ahmed Ak Elmassry
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Hafezi F, Hosny M, Shetty R, Knyazer B, Chen S, Wang Q, Hashemi H, Torres-Netto EA. PACK-CXL vs. antimicrobial therapy for bacterial, fungal, and mixed infectious keratitis: a prospective randomized phase 3 trial. EYE AND VISION (LONDON, ENGLAND) 2022; 9:2. [PMID: 34996516 PMCID: PMC8742313 DOI: 10.1186/s40662-021-00272-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/27/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Infectious keratitis is a major cause of global blindness. We tested whether standalone photoactivated chromophore corneal cross-linking (PACK-CXL) may be an effective first-line treatment in early to moderate infectious keratitis, compared with standard antimicrobial treatment. METHODS This is a randomized, controlled, multinational phase 3 clinical trial. Participants in five centers in Egypt, India, Iran, Israel, and China, aged ≥ 18 years, with infectious keratitis of presumed bacterial, fungal, or mixed origin, were randomly assigned (1:1) to PACK-CXL, or antimicrobial therapy. Outcomes measures included healing, defined as time to re-epithelialization of the corneal epithelial defect in the absence of inflammatory activity in the anterior chamber and clearance of stromal infiltrates. Treatment success was defined as the complete resolution of signs of infection. RESULTS Between July 21, 2016, and March 4, 2020, participants were randomly assigned to receive PACK-CXL (n = 18) or antimicrobial therapy per American Academy of Ophthalmology (AAO) guidelines (n = 21). No participants were lost to follow-up. Four eyes were excluded from the epithelialization time analysis due to treatment failure: two in the antimicrobial therapy group, and two in the PACK-CXL group. Success rates were 88.9% (16/18 patients) in the PACK-CXL group and 90.5% (19/21 patients) in the medication group. There was no significant difference in time to complete corneal re-epithelialization (P = 0.828) between both treatment groups. CONCLUSIONS PACK-CXL may be an alternative to antimicrobial drugs for first-line and standalone treatment of early to moderate infectious keratitis of bacterial or fungal origin. Trial registration This trial is registered at ClinicalTrials.gov, trial registration number: NCT02717871.
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Affiliation(s)
- Farhad Hafezi
- Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland. .,ELZA Institute, Dietikon, Switzerland. .,Faculty of Medicine, University of Geneva, Geneva, Switzerland. .,Department of Ophthalmology, Medical University of Wenzhou, Wenzhou, China. .,USC Roski Eye Institute, University of Southern California Los Angeles, Los Angeles, USA.
| | - Mohammed Hosny
- Department of Ophthalmology, University of Cairo, Cairo, Egypt
| | - Rohit Shetty
- Narayana Nethralaya Eye Hospital and the Postgraduate Institute of Ophthalmology, Bangalore, India
| | - Boris Knyazer
- Department of Ophthalmology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Shihao Chen
- Department of Ophthalmology, Medical University of Wenzhou, Wenzhou, China
| | - Qinmei Wang
- Department of Ophthalmology, Medical University of Wenzhou, Wenzhou, China
| | - Hassan Hashemi
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Emilio A Torres-Netto
- Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland.,ELZA Institute, Dietikon, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland.,University Hospital Zurich, Zurich, Switzerland
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Altamirano D, Martinez J, Leviste KD, Parel JM, Amescua G. Photodynamic Therapy for Infectious Keratitis. CURRENT OPHTHALMOLOGY REPORTS 2021; 8:245-251. [PMID: 34540359 DOI: 10.1007/s40135-020-00252-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Infectious keratitis is a sight-threatening microbial infection. The prevalence of antimicrobial resistance in cases of infectious keratitis has increased the demand for fortified compounded antimicrobial drops. Even with proper medical management, severe cases of infectious keratitis can further evolve into corneal perforation, requiring surgical intervention in the form of keratoplasty to control the infectious process. Due to the invasive nature of the procedure and the shortage of available donor tissue around the world, alternative treatments are needed for the management of progressive infectious keratitis. In ophthalmology, photodynamic therapy (PDT) has been used for numerous applications. PDT with Rose Bengal as a photosensitizer combined with green light optical irradiation (RB-PDAT) is a novel treatment with dual purpose: to arrest the infection from progressing and strengthen the collagen of the cornea. RB-PDAT may be considered as an adjunct therapy in severe cases of infectious keratitis to minimize the need for a therapeutic keratoplasty.
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Affiliation(s)
- Diego Altamirano
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jaime Martinez
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Katherine D Leviste
- Ocular Microbiology Laboratory, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jean Marie Parel
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Ophthalmic Biophysics Center, McKnight Vision Research Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Guillermo Amescua
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
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Kokuti R. Medical treatment of keratomalacia in a cat. VETERINARY RECORD CASE REPORTS 2019. [DOI: 10.1136/vetreccr-2019-000820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ting DSJ, Henein C, Said DG, Dua HS. Photoactivated chromophore for infectious keratitis - Corneal cross-linking (PACK-CXL): A systematic review and meta-analysis. Ocul Surf 2019; 17:624-634. [PMID: 31401338 DOI: 10.1016/j.jtos.2019.08.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/29/2019] [Accepted: 08/07/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE To examine the efficacy of adjuvant photoactivated chromophore for infectious keratitis-corneal cross-linking (PACK-CXL) for the treatment of infectious keratitis (IK). METHODS Electronic databases, including MEDLINE, EMBASE and Cochrane Central, were searched for articles related to PACK-CXL. All clinical studies, including randomized controlled trials (RCTs), non-randomized controlled studies, case series and case reports, were included. A meta-analysis was further performed when there were sufficient similarities in the included RCTs. Primary outcome measure was time to complete corneal healing and secondary outcome measures included size of epithelial defect and infiltrate, corrected-distance-visual-acuity (CDVA), and adverse events. RESULTS Forty-six eligible studies (including four RCTs) with 435 patients were included. When compared to standard antimicrobial treatment (SAT) alone, adjuvant PACK-CXL resulted in shorter mean time to complete corneal healing (-7.44 days; 95% CI, -10.71 to -4.16) and quicker resolution of the infiltrate at 7 days (-5.49 mm2; 95% CI, -7.44 to -3.54) and at 14-30 days (-5.27 mm2; 95% CI, -9.12 to -1.41). There was no significant difference in the size of epithelial defect, CDVA and risk of adverse events. Evidence on the use of PACK-CXL in acanthamoeba and mixed IK was insufficient. CONCLUSIONS Our study demonstrates that adjuvant PACK-CXL expedites the healing of IK when compared to SAT alone (low-quality evidence). Further adequately powered, high-quality RCTs are required to fully ascertain the therapeutic effect of PACK-CXL.
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Affiliation(s)
- Darren Shu Jeng Ting
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK; Department of Ophthalmology, Queen Medical Centre, Nottingham, UK.
| | - Christin Henein
- Newcastle University, Newcastle Upon Tyne, UK; National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Dalia G Said
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK; Department of Ophthalmology, Queen Medical Centre, Nottingham, UK
| | - Harminder S Dua
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK; Department of Ophthalmology, Queen Medical Centre, Nottingham, UK
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Hellander Edman A, Ström L, Ekesten B. Corneal cross-linking (CXL)-A clinical study to evaluate CXL as a treatment in comparison with medical treatment for ulcerative keratitis in horses. Vet Ophthalmol 2019; 22:552-562. [PMID: 31012258 DOI: 10.1111/vop.12662] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 02/17/2019] [Accepted: 02/20/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Compare CXL treatment with medical treatment alone in horses with stromal, ulcerative keratitis. ANIMALS STUDIED 24 horses (24 eyes) with stromal, ulcerative keratitis were included. PROCEDURE 12 horses were initially treated with CXL, and 12 horses were given conventional medical treatment. Topical medical treatment was added to horses in the CXL group if necessary. Parameters including cytology, microbial growth, time to fluorescein negativity, and time to inhibition of stromal melting were evaluated. RESULTS After the first day of treatments, a decrease in inflammatory signs and pain from the eye was observed in both groups. Stromal melting ceased within 24 hours regardless of treatment. CXL treatment alone was sufficient in 3 horses with noninfectious, superficial stromal ulcerations. Clinical signs of impaired wound healing were seen after 3-14 days in corneas with suspected or proven bacterial infection treated with CXL only, most likely because of insufficient elimination of bacteria deeper in the corneal stroma or because of re-infection from bacteria in the conjunctiva. The average decrease in stromal ulcer area per day after onset of treatment was almost identical between the groups, and no significant difference in time to fluorescein negativity was found. CONCLUSIONS We consider CXL a possible useful adjunct treatment of corneal stromal ulcers in horses, especially for melting ulcers and as a potential alternative to prophylactic antibiotic treatment for noninfected stromal ulcers. However, CXL should not be used alone for infected or suspected infected stromal ulcers, because topical antibiotics were required in all horses with proven infectious keratitis.
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Affiliation(s)
- Anna Hellander Edman
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Lena Ström
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Björn Ekesten
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
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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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Reply. Am J Ophthalmol 2016; 168:294-295. [PMID: 27292530 DOI: 10.1016/j.ajo.2016.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 05/18/2016] [Indexed: 11/22/2022]
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Hafezi F, Kling S. Photoactivated Chromophore for Moderate to Severe Infectious Keratitis as an Adjunct Therapy: A Randomized Controlled Trial. Am J Ophthalmol 2016; 168:293-294. [PMID: 27292531 DOI: 10.1016/j.ajo.2016.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 05/03/2016] [Indexed: 10/21/2022]
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Chan TCY, Lau TWS, Lee JWY, Wong IYH, Jhanji V, Wong RLM. Corneal collagen cross-linking for infectious keratitis: an update of clinical studies. Acta Ophthalmol 2015; 93:689-96. [PMID: 25990098 DOI: 10.1111/aos.12754] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 03/30/2015] [Indexed: 11/30/2022]
Abstract
Collagen cross-linking (CXL) with ultraviolet light-activated riboflavin is a corneal surface procedure developed for the treatment of keratoconus and corneal ectasia. With the known microbicidal and corneal stiffening effects of ultraviolet irradiation and photoactivated riboflavin, it has recently been introduced for the management of infectious keratitis, especially for ulcers resistant to antimicrobial therapy or associated with corneal melting. Various authors have attempted to use CXL as an adjunctive, salvage or even as the sole treatment for infectious corneal ulcers. The aim of this review was to provide a summary of the clinical studies in the literature. It is worth noting that there is still no consensus on the treatment protocol of CXL against infectious keratitis. The disparities in outcome measures, treatment protocol and study design can confound the interpretation and hamper the generalization of the study results. Based on current evidence, the role of CXL in infectious keratitis remained unclear despite the reported success in some clinical cases. Further investigations are warranted concerning the efficacy and safety of treating infectious keratitis with CXL.
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Affiliation(s)
- Tommy C. Y. Chan
- Hong Kong Eye Hospital; Hong Kong SAR China
- Department of Ophthalmology and Visual Sciences; The Chinese University of Hong Kong; Hong Kong SAR China
| | - Tiffany W. S. Lau
- Hong Kong Eye Hospital; Hong Kong SAR China
- Department of Ophthalmology and Visual Sciences; The Chinese University of Hong Kong; Hong Kong SAR China
| | - Jacky W. Y. Lee
- Department of Ophthalmology; The University of Hong Kong; Hong Kong SAR China
| | - Ian Y. H. Wong
- Department of Ophthalmology; The University of Hong Kong; Hong Kong SAR China
| | - Vishal Jhanji
- Hong Kong Eye Hospital; Hong Kong SAR China
- Department of Ophthalmology and Visual Sciences; The Chinese University of Hong Kong; Hong Kong SAR China
| | - Raymond L. M. Wong
- Hong Kong Eye Hospital; Hong Kong SAR China
- Department of Ophthalmology and Visual Sciences; The Chinese University of Hong Kong; Hong Kong SAR China
- Department of Ophthalmology; The University of Hong Kong; Hong Kong SAR China
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Randleman JB, Khandelwal SS, Hafezi F. Corneal cross-linking. Surv Ophthalmol 2015; 60:509-23. [PMID: 25980780 DOI: 10.1016/j.survophthal.2015.04.002] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 04/28/2015] [Accepted: 04/30/2015] [Indexed: 12/26/2022]
Abstract
Since its inception in the late 1990s, corneal cross-linking has grown from an interesting concept to a primary treatment for corneal ectatic disease worldwide. Using a combination of ultraviolet-A light and a chromophore (vitamin B2, riboflavin), the cornea can be stiffened, usually with a single application, and progressive thinning diseases such as keratoconus arrested. Despite being in clinical use for many years, some of the underlying processes, such as the role of oxygen and the optimal treatment times, are still being worked out. More than a treatment technique, corneal cross-links represent a physiological principle of connective tissue, which may explain the enormous versatility of the method. We highlight the history of corneal cross-linking, the scientific underpinnings of current techniques, evolving clinical treatment parameters, and the use of cross-linking in combination with refractive surgery and for the treatment of infectious keratitis.
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Affiliation(s)
- J Bradley Randleman
- Department of Ophthalmology, Emory University, Atlanta, Georgia, USA; Emory Vision, Emory Eye Center, Atlanta, Georgia, USA.
| | | | - Farhad Hafezi
- ELZA Institute, Zurich, Switzerland; Laboratory for Ocular Cell Biology, University of Geneva, Geneva, Switzerland; Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA; Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland
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Famose F. Evaluation of accelerated corneal collagen cross-linking for the treatment of bullous keratopathy in eight dogs (10 eyes). Vet Ophthalmol 2015; 19:250-255. [PMID: 25959108 DOI: 10.1111/vop.12280] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Bullous keratopathy (BK) is a serious corneal condition leading to impaired vision and ocular pain, due to chronic corneal edema and recurrent superficial ulceration. BK is refractory to conventional therapy. In human patients, corneal collagen cross-linking (CXL) has been used for the treatment of BK, and CXL treatment was recently described for canine patients. The aim of this study was to evaluate the clinical and pachymetric effects of accelerated CXL in dogs affected by BK. ANIMAL STUDIED Eight dogs (10 eyes) with BK underwent accelerated CXL. PROCEDURES CXL treatment comprised 30 min of riboflavin-dextran instillation, followed by 3 min of UVA irradiation at 30 mW/cm². Ocular pain, corneal edema, corneal ulceration, and pachymetry were evaluated 7, 14, 30, 90, and 180 days after treatment. RESULTS Corneal ulceration and ocular pain were resolved by 1 week after CXL treatment and did not recur during the 6-month follow-up period. Corneal edema improved in the first 3 months, but worsened from months 3 to 6. Corneal thickness initially decreased, but returned to baseline by 6 months post-CXL. CONCLUSIONS CXL is a useful treatment option for BK in dogs, despite the short-lasting effects on corneal thickness. Patient comfort improved rapidly after a single procedure, although CXL did not achieve resolution of corneal edema. Treatment protocols may be refined to produce more durable effects on corneal edema.
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Affiliation(s)
- Frank Famose
- Clinique vétérinaire, Ophtalmologie, 42 avenue Servanty, Blagnac, 31700, France
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Arbelaez JG, Feng MT, Pena TJ, Price MO, Price FW. A year of cornea in review: 2013. Asia Pac J Ophthalmol (Phila) 2015; 4:40-50. [PMID: 26068612 DOI: 10.1097/apo.0000000000000110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The goal of this study was to provide an update of significant corneal literature published in 2013. DESIGN This study is a systematic literature review. METHODS We conducted a systematic review of the English-language literature published from January 1, 2013, to December 31, 2013, using the following PubMed search and Medical Subject Headings terms: cornea transplantation, keratoplasty, Descemet membrane endothelial keratoplasty, Descemet stripping endothelial keratoplasty, cross linking, pre-Descemet's layer, Rho-associated kinase, keratoprosthesis, infectious keratitis, corneal dystrophy, corneal astigmatism, and keratoconus. RESULTS This review summarizes relevant and innovative original articles, review articles, and novel techniques from the following journals: American Journal of Ophthalmology, British Journal of Ophthalmology, Cornea, Graefe's Archive for Clinical and Experimental Ophthalmology, Investigative Ophthalmology & Visual Science, JAMA Ophthalmology, Journal of Cataract and Refractive Surgery, Journal of Refractive Surgery, and Ophthalmology. Case reports, abstracts, letters to the Editor, and unpublished work were excluded, as well as articles e-published ahead of print in 2012 that were discussed in the previous review. One hundred twenty-seven articles met the criteria for this review. CONCLUSIONS This review summarizes significant cornea-related literature from 2013.
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Affiliation(s)
- Juan G Arbelaez
- From the *Price Vision Group; and †Cornea Research Foundation of America, Indianapolis, IN
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Richoz O, Kling S, Hoogewoud F, Hammer A, Tabibian D, Francois P, Schrenzel J, Hafezi F. Antibacterial Efficacy of Accelerated Photoactivated Chromophore for Keratitis–Corneal Collagen Cross-linking (PACK-CXL). J Refract Surg 2014; 30:850-4. [DOI: 10.3928/1081597x-20141118-01] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 10/20/2014] [Indexed: 11/20/2022]
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Chan E, Snibson GR, Sullivan L. Treatment of infectious keratitis with riboflavin and ultraviolet-A irradiation. J Cataract Refract Surg 2014; 40:1919-25. [DOI: 10.1016/j.jcrs.2014.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 06/17/2014] [Accepted: 06/17/2014] [Indexed: 10/24/2022]
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