In a recent feature, Ocular Surgery News (OSN) provided an in-depth overview of the latest advancements in PACK-CXL for the treatment of corneal infections, as presented by Prof. Farhad Hafezi of the ELZA Institute at the Winter ESCRS meeting in Frankfurt, Germany. While CXL is well-established for treating keratoconus, Prof. Hafezi’s latest presentation focused on its transformative potential for managing infectious keratitis.
The Dual Role of Cross-Linking: Biomechanics and Infection Control
Traditional cross-linking for keratoconus relies on riboflavin and ultraviolet (UV) light to stiffen the cornea through oxygen-dependent biomechanical processes. However, as Prof. Hafezi explained, oxygen is not a limiting factor when using CXL to kill bacteria and fungi or to enhance tissue resistance against enzymatic digestion.
These findings open new avenues for treating infectious keratitis. By removing oxygen as a critical variable, the procedure can be performed more rapidly and at higher energy levels, streamlining treatment without compromising its efficacy.
Key Findings on Oxygen-Independent Cross-Linking
Prof. Hafezi shared groundbreaking results from experiments using riboflavin and green light with rose bengal to assess their effects on corneal resistance to digestion in the presence and absence of oxygen. The results confirmed that oxygen is unnecessary for both antimicrobial activity and the enhancement of corneal resilience.
This discovery simplifies the approach to treating infectious keratitis. Faster, high-energy protocols become viable, offering clinicians practical tools to combat corneal infections more efficiently.
Implications for Clinical Practice
These advancements could redefine treatment protocols for infectious keratitis, emphasizing speed and efficacy. By optimizing cross-linking techniques to eliminate dependency on oxygen, ophthalmologists can deliver rapid interventions, even in resource-limited settings.
Conclusion
The ELZA Institute’s research, led by Prof. Hafezi, continues to expand the scope of cross-linking technology. From biomechanical stabilization in keratoconus to innovative approaches in managing corneal infections, these advancements hold significant promise for improving patient outcomes. As clinical validation progresses, the ophthalmic community anticipates adopting these simplified, accelerated methods as a standard of care.
Transcript:
This is Farhad Hafezi from Switzerland, and we are at the winter ESCRS meeting in Frankfurt, Germany.
One of the main elements that fascinates me about cross-linking is this infection control.
So treat infectious keratitis with UV light and riboflavin or even with green light and rose bengal.
In classic cross-linking for keratoconus, we are limited by oxygen necessity. We need oxygen in the tissue to perform the biomechanical stiffening effect.
But we are curious to see: do we need oxygen for killing bacteria and fungi, and do we need it to increase the tissue’s resistance against digestion?
The first one was answered already almost ten years ago.
We have shown that in order to kill bacteria, you do not need oxygen molecules within the stroma.
What does that mean for clinics?
It means you can go fast and you can use as much energy as your LED can deliver.
We do not have to take into consideration gentle acceleration because of oxygen.
We wanted to know the same for digestion and resistance to digestion, so we performed experiments treating corneas by cross-linking using riboflavin, using rose bengal, even combining the two, and then checking how resistant the tissue becomes in the presence and in the absence of oxygen.
And the outcome was: oxygen does not play a role.
Which again means to kill and to increase resistance, we can go very fast with very high fluorescence.
And that’s really good because this is what we need in clinical practice: a fast and effective treatment.
