Photoactivated riboflavin treatment of infectious keratitis using collagen cross-linking technology

J Refract Surg. 2012 Oct;28(10):706-13. doi: 10.3928/1081597X-20120921-06.

Abstract

Purpose: To evaluate riboflavin/ultraviolet-A (UVA) as an adjunct treatment for infectious keratitis.

Methods: This prospective, dual-center, interventional case series included cases of infectious keratitis that were treated by instilling riboflavin 0.1% solution for 30 minutes to saturate the cornea, followed by exposure to 365-nm UVA light (3 mW/cm(2)) for 15 to 45 minutes, with continued instillation of riboflavin. Eyes continued on standard antibiotic treatment. The primary outcome measures were the times to resolution of the infiltrate and the epithelial defect.

Results: Forty patients aged 14 to 86 years were enrolled. Seven (18%) eyes had a previous keratoplasty. Bacterial species were identified in 24 eyes, fungal in 7, protozoan in 2, viral in 1, and no organism in 6. The maximum infiltrate diameter ranged from 1 to 12 mm and the epithelial defect diameter was 0 to 8 mm before treatment. In 6 cases (2 bacterial, 3 fungal, and 1 without growth), the keratitis did not resolve successfully and the eye received a penetrating keratoplasty (PK). In 1 eye with prior PK, the infection resolved following treatment, but a regraft was required to address perforation of the PK incision.

Conclusions: Riboflavin/UVA should be avoided in eyes with prior herpes simplex but otherwise posed no obvious safety risk in this series and appeared to be most effective when the infection depth was limited. The success rate was higher for bacterial infections than fungal infections. Randomized studies against antibiotics alone are needed to further evaluate efficacy.

Publication types

  • Multicenter Study

MeSH terms

  • Acanthamoeba / isolation & purification
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Bacteria / isolation & purification
  • Collagen / metabolism*
  • Corneal Stroma / metabolism
  • Cross-Linking Reagents / therapeutic use*
  • Eye Infections / drug therapy*
  • Eye Infections / metabolism
  • Eye Infections / microbiology
  • Eye Infections / parasitology
  • Female
  • Fungi / isolation & purification
  • Humans
  • Keratitis / drug therapy*
  • Keratitis / metabolism
  • Keratitis / microbiology
  • Keratitis / parasitology
  • Keratoplasty, Penetrating
  • Male
  • Middle Aged
  • Photochemotherapy*
  • Photosensitizing Agents / therapeutic use*
  • Pilot Projects
  • Prospective Studies
  • Riboflavin / therapeutic use*
  • Treatment Failure
  • Treatment Outcome
  • Ultraviolet Rays
  • Young Adult

Substances

  • Cross-Linking Reagents
  • Photosensitizing Agents
  • Collagen
  • Riboflavin