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PACK-CXL: Cross-linking the cornea… to conquer infection

EyeWorld’s Jonathan Kahn (JK) interviews Farhad Hafezi (FH) for a PACK-CXL update.


JK: Good morning from the ESCRS conference in Vienna Austria. We’re pleased to have again Dr. Farhad Hafezi from Switzerland. Thanks a lot for being with us today.

FH: Thank you.

JK: I’d like to speak with you this morning about a different type of cross-linking treatment which has been evolving for us, which is using cross-linking to treat microbial keratitis or infectious keratitis. You and others have done quite a bit of work on this topic but I understand that there’s some new information that you’d like to present. Tell us about that.

FH: Yes, we’ve been in tight collaboration with Boris Knyaser from Israel, who has run a very interesting study that has just been submitted now, and basically he has compared two arms in infectious keratitis: one arm is conventional antimicrobial treatment, and the other is antibiotics plus PACK crosslinking. And what he has found, and the numbers are quite high: it’s 40 eyes in in one arm, 32 eyes in the combined arm.

What he has found is that the time to healing was substantially faster; significantly faster in the combined procedure arm. In other words, if you add a cross-linking procedure to antibiotics, the corneas, with an average also size of more than 3 mm, they healed in seven days as opposed to 12 days in the antibiotics only arm.

JK: Well, this is really not surprising data, but it’s interesting data to support the use of cross-linking in treating infectious keratitis. I’m curious were these cases the more severe cases of infectious keratitis? Were they more mild cases or did they run a gamut there?

FH: These were intermediate ulcers according to the classification of the Academy, but what makes it interesting is two things: first of all they retreated in an accelerated protocol – so not for half an hour, but for a few minutes only. And the second issue is this is still done with the fluence of 5.4 J/cm² as we do in conventional cross-linking. We will go up to 7.2 J/cm² – even higher in newer protocols to increase the efficacy of the method.

JK: Do you think that it’s possible that cross-linking may be proposed as a standalone treatment for infectious keratitis? Do you think that a trial comparing cross-linking alone versus topical antibiotics may be considered instead of cross-linking with antibiotics?

FH: This might be the case in very ulcers, but I think more realistic would be to shorten the time of antibiotic regimen, so instead of giving antibiotics for two weeks it might be a few days only. But our multicenter trial is doing exactly this: antibiotics alone versus cross-linking alone. We have a little more than twenty eyes in the study now and the first results look quite promising.

JK: Well, we will look forward to the results of that study when they become available, and again thank you so much for explaining this very important topic, which is collagen cross-linking in infectious keratitis. Thanks again.

FH: Thank you.


The ELZA Institute

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