- Farhad Hafezi, Nanji Lu, Scientific article
New study reveals how accelerated PACK-CXL with riboflavin/UV-A or rose bengal/green light can be effective treatments for bacterial keratitis.
- by Prof. Farhad Hafezi
- December 31, 2023
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.
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.
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.
There are a number of reasons to use this new method:
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
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.
Cornea: Infectious Keratitis
Terrien’s Marginal Degeneration
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