ESCRS - PP23.16 - Review Of The Literature On The Currently Available Evidence For The Management Of Infectious Keratitis With Pack-Cxl

Review Of The Literature On The Currently Available Evidence For The Management Of Infectious Keratitis With Pack-Cxl

Published 2022 - 40th Congress of the ESCRS

Reference: PP23.16 | Type: ESCRS 2022 - Posters | DOI: 10.82333/yfcr-9w88

Authors: Sidi Mohamed Hamida Abdelkader* 1 , Marina Rodríguez Calvo-de-Mora 2 , Jose Antonio Gegúndez-Fernández 3 , Fernando Luis Soler-Ferrández 4 , Carlos Rocha-de-Lossada 5

1Ophthalmology,H. Torrecárdenas,Almeria,Spain, 2Ophthalmology,Hospital Regional Universitario de Málaga,Málaga,Spain, 3Ophthalmology,Hospital Clínico San Carlos de Madrid,Mádrid,Spain, 4Ophthalmology,Innova Ocular Clínica Dr. Soler,Elche (Alicante),Spain, 5Ophthalmology,Qvision, Hospital Vithas Vírgen Del Mar,Almeria,Spain

Purpose

The objective of this systematic review is to update the available evidence on the efficacy and safety of PACK-CXL (Photoactivated chromophore for corneal cross-linking in the treatment of infectious keratitis) in infectious keratitis (IK).

Setting

H. Torrecárdenas Almería (Spain); Hospital Regional Universitario de Málaga (Spain); Hospital Clínico San Carlos de Madrid (Spain); Innova Ocular Clínica Dr Soler (Spain); Qvision, Hospital Vithas Vírgen Del Mar de Almería (Spain); Hospital Universitario Vírgen de las Nieves de Granada (Spain)

Methods

The literature search focused on obtaining comparative studies on the efficacy and safety of PACK-CXL for the treatment of IK. This search was performed in the following databases: Cochrane Library, PubMed, EMBASE, Web of Science, Ovid MEDLINE and Scopus

Results

There is insufficient evidence to support the combination therapy of PACK-CXL with topical medication, as a safe and effective treatment for bacterial keratitis (BK), Acanthamoeba queratitis and mixed keratitis. PACK-CXL is contraindicated in viral keratitis, due to the possibility of exacerbating herpes simplex virus infection. CLAIR study did not show any benefit of adjuvant PACK-CXL in the treatment of fungal keratitis (FK), either at 3 or at 12 months of follow-up, and it may even produce a decrease in visual acuity. The SCUT II study protocol has recently been published, where the authors hope that the results of this work will provide evidence of the efficacy of PACK-CXL and early steroids as complementary treatments in BK 

Conclusions

In summary, the current evidence on the effectiveness of PACK-CXL for the management of IK seems to be low, clinically heterogeneous in terms of results, and with doubtful safety in certain aetiologies. Currently, there are five ongoing RCTs (randomized clinical trials) with 1,136 participants, which we hope could provide more concrete and clarifying answers