Pack-Cxl In Infectious Keratitis: First-Line Or Salvage Treatment

Published 2022 - 40th Congress of the ESCRS

Reference: PO266 | Type: ESCRS 2022 - Posters | DOI: 10.82333/w4vd-ph02

Authors: Chiara Bonzano* ¹ , Carlo Alberto Cutolo ¹ , Catti Carlo ¹ , Gabriele Siccardi ¹ , Carlo Enrico Traverso ¹

¹University of Genoa and Ospedale Policlinico San Martino, Genoa, Italy,Clinica Oculistica,genova,Italy

Purpose

To report a successful Photoactivated Chromophore for Keratitis-Corneal Collagen Cross-Linking (PACK-CXL) as a first-line treatment in Serratia marcescens keratitis.

Setting

Clinica Oculistica, Di.N.O.G.M.I. University of Genoa and Ospedale Policlinico San Martino, Genoa, Italy

Methods

Clinical and imaging description of a clinical case. Slit-lamp examination, anterior segment optical coherence tomography (AS-OCT), and anterior segment photography were performed during the first examination and at each follow-up visit.

Results

An 87-year-old Caucasian male complained about blurry vision within his left eye for about two days. Our first evaluation revealed a corneal ulcer. We performed both in vivo confocal microscopy and a corneal scraping. First, we performed PACK-CXL in accelerated high-fluence mode (30 mW/cm² for 4minutes). Then, a preservative-free single-dose eye lubricant was administered concomitant to hourly instillations of topical fortified antibiotics plus bandage contact lens. The hypopyon had disappeared 24 hours later, and the corneal ulcer improved after a few days. Corneal scraping revealed a multidrug-resistant Serratia marcescens. Two weeks later, the cornea markedly ameliorated with combined improvement in visual acuity.

Conclusions

After appropriate oncological surgery on the eyelids, the reconstruction must be extremely precise to preserve the eyelid function and avoid consecutive exposure keratopathy and infectious keratitis. Performed as a primary treatment to topical antibiotics, PACK-CXL has been extremely useful in treating Serratia marcescens keratitis. It has shown a triple benefit: avoiding re-perforation by immediately stopping corneal melting and quickly stopping infection, which can become increasingly important in the context of increasing antimicrobial resistance. It also prevented emergency keratoplasty, which is associated with higher rates of infection and rejection.