PACK cross-linking in keratitis

UV light and Vitamin B₂

The use of ultraviolet light and vitamin B₂ (riboflavin) to sterilize surfaces and solutions is not new. This combination has been used for decades in medicine and the chemical industry. For example, the number of microbes in large Olympic swimming pools is often reduced with vitamin B₂ and sunlight. In addition, the technology has been used for years to reduce the number of bacteria in blood transfusions. In addition, there was also the SODIS (Solar Disinfection) technology developed by ETH Zurich to reduce the burden of drinking water with microbes. Here, vitamin B₂ is added to water in PET bottles and exposed to direct sunlight for several hours. After this treatment, bacteria, fungi and even viruses in the bottle are killed.

UV light and vitamin B₂ are the components of the cross-linking of the cornea, which has been used since 2002 for the treatment of keratoconus and which we have co-developed significantly. The question then arose as to whether the method could possibly also be used for corneal infections.

Pioneered in Zurich: cross-linking for corneal infections

In 2006 and 2007, our group in Zurich treated the world’s first patients with this new method. Only patients who show no improvement after treatment with antibiotics were treated. The success was promising and the beginning of a branch of research that is becoming increasingly important.

   

PACK-Cross-Linking (PACK-CXL)

At the International Cross-Linking Congress in Zurich in 2014, Farhad and Nikki Hafezi proposed a new term to better describe cross-linking for infections: PACK-CXL (photoactivated chromophore for infectious keratitis). The proposal was accepted and has since been used for this new treatment method.

Before PACK-CXL

After PACK-CXL

Reasons to use PACK-CXL

There are a number of reasons to use this new method:

  • Mixed infections:
    in many countries of the world, the corneal infections are not bacterial but mixed, that is caused by bacteria and fungi. Antibiotics alone do not help here. PACK cross-linking kills bacteria and fungi.
  • Therapeutic and diagnostic dilemma: at the beginning of an infection it is sometimes very difficult to assess whether the infection is caused by bacteria or fungi. Accordingly, it is difficult to select the appropriate therapy. PACK cross-linking simplifies the approach by simultaneously killing bacteria and fungi.
  • Financial burden: in many countries of the world, the corneal infection can not be successfully treated for financial reasons. The costs are less due to the medication than through the many doctor visits that are necessary. One-time PACK cross-linking reduces the total number of visits required by the doctor.

How does PACK-CXL work?

It works in three different ways:

1. It prevents microorganisms from multiplying by deactivating the genetic material,
2. It kills microorganisms directly by a very high oxidative stress and
3. It increases the resistance of the tissue to the inflammatory digestion.

1 Intercalation with DNA = stops replication

2 Oxidative stress

3 Increased resistance to digestion

PACK-CXL clinical trial

A large, international, multicenter phase III trial that involved patients with infectious keratitis that was thought to be caused by bacteria, fungi or a mixture of the two was published in 2021. Patients were treated with either PACK-CXL alone, or standard antimicrobial therapy. “Treatment success” was defined as the complete resolution of any sign of infection- and time to re-epithelialzation (where the cells at the top of the cornea have regrown over the site of infection). The result: both treatments were about 90% successful, and there was no difference in time to re-epithelialisation between treatment groups.

Click here to read the manuscript.

PACK-CXL videos

PACK-CXL Posts

Today, a landmark PACK-CXL trial was published that shows that PACK-CXL is an effective corneal infection therapy.
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Augeninstitut ELZA
4.8
Based on 107 reviews
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Serena Fazio
Serena Fazio
11:15 06 Mar 22
I have been to the ELZA clinic to have surgery for my miopy, as my eyes were rejecting the contacts and I was tired of... wearing glasses. From the first preliminary visit, to the actual surgery and post-surgery care Dr. Hafezi and all his collaborators have been extremely professional, considerate and helpful. All the steps of the (very short!) surgery were thoroughly explained to me in order to be as calm as possible, together with the medication plan and precautions to be aware of so that my eyes could heal in the best way possible. By following their exact instructions, the healing process has been very successful and smooth, and after about one week I was able to see perfectly. I absolutely recommend this team and their expertise!read more
Robin A
Robin A
11:43 16 Feb 22
Top experts and professional team. Highly recommended
Thunder Shiviah
Thunder Shiviah
14:05 23 Nov 21
After some research on local options I decided to go with ELZA since it stood out as the best. The operation and the... post-operation recovery went extremely smooth (something I was worried about with PRK). Now my vision is much better than I had hoped and I have no side effects such as dry eye or night vision problems. Thank you!read more
Squitieri Elias
Squitieri Elias
12:43 08 Sep 21
Die Behandlungen waren bei mir erfolgreich, alle waren sehr nett und haben mein Leben vereinfacht.Danke
Eliane Bossart
Eliane Bossart
13:01 05 Sep 21
Vor einem Jahr war ich einer ganz verzweifelten Situation und total im Stich gelassen. Meine Augen wurden aufgrund... eines ausgeprägten Kerakotonus immer schlechter, ich hatte Angst und war alleine mit meinen Problemen. Zudem vertrug ich die Kontaktlinsen nur noch ganz schlecht und hatte jeden Tag Schmerzen.Professor Hafezi hat mir mit zwei Operationen wieder das auf Grund der Situation mögliche an Lebensqualität zurückgebracht. Es war ein starpaziöses Jahr mit vielen Entbehrungen aber es hat sich gelohnt! Herzlichen Dank fuer die Unterstützung.read more
Gabriela Meyer
Gabriela Meyer
18:32 22 Aug 21
Ich wurde von meiner Optikerin auf Prof. Dr. Dr. Hafezi aufmerksam gemacht. Es war mir vorher nicht bewusst, dass meine... Augenkrankheit (Keratokonus) operativ mittels Cross Linking behandelt und so gestoppt werden kann. Die Beratung und Behandlung war sehr kompetent und ich fühlte mich jederzeit wohl. Die Operation verlief gut und das Ergebnis ist einwandfrei.read more
Naomi
Naomi
11:38 11 Aug 21
Ich bin sehr glücklich, dass ich das Elza Institute gefunden habe. Ich wurde von anderen Augenärzten abgewiesen, da... meine Augen zu kompliziert/schwierig zu behandeln waren. Prof. Dr. Dr. Hafezi konnte mir jedoch helfen und ich bin sehr glücklich und zufrieden mit dem Resultat. Vielen Dank!read more
Till B
Till B
08:30 19 Jul 21
Ich habe eine überaus kompetente Beratung und Behandlung erlebt. Die gesamte Betreuung war sehr freundlich und... professionell. Herzlichen Dank!read more
Thomas S.
Thomas S.
09:37 07 Jul 21
My left eye had to be operated on because of a cataract. As I had an Artiflex lens implanted a few years ago, it had to... be removed first before a modern lens could be implanted to correct the cataract. Prof. Hafezi treated me in an very competent and friendly manner. I am very happy with the result.read more
Selma A. Rahim
Selma A. Rahim
19:45 02 Jul 21
Dr. Hafezi.. the KING OF CXL🤴
Gianluca Ricci
Gianluca Ricci
12:46 10 Apr 21
Great team and service!
rehaneyecare
rehaneyecare
05:36 08 Apr 21
Excellent surgeon
Steven H.A
Steven H.A
16:13 11 Jan 21
Prof. F. Hafezi s expertise is enormous and he has a very pleasant and calm nature which gives the patient... security.Thank youread more
Online Commande
Online Commande
09:19 05 Dec 20
Totally creepy, very arrogant Prof.He just want your money.It may explain, why this Prof. is not in the center of the... city of Zürich and why he has been thrown away from University of Geneva.read more
Elena Churilova
Elena Churilova
10:06 17 Nov 20
At the moment, 3 months have passed since the moment I made laser vision correction in this clinic. and I can say that... I am happy that I chose this particular clinic and Prof. F. Hafezi. The entire staff of the clinic is very friendly, treats patients with sympathy and patience if they are nervous before surgery (my big gratitude to Aida Alili for all support and patience). The doctor Hafezi and other doctors of the clinic are very professional and ready to explain to you as many times as you need. I can only recommend!read more
Ashley Faulkes
Ashley Faulkes
15:30 21 Mar 16
Professor Hafezi and the team at the ELZA Institute have done an amazing job of creating a first class eye clinic, with... cutting edge technology and support. I went there for a dry eye issue and other issues with my prescription, and they were easily able to help me and put me on the road to better vision! High recommend them to anyone in the Zurich/Aargau area.read more
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