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. 2023 Apr;43(4):1241-1248.
doi: 10.1007/s10792-022-02522-z. Epub 2022 Oct 18.

Corneal cross-linking guards against infectious keratitis: an experimental model

Ayah Marrie  1 , Abdussalam M Abdullatif  1 , Sherief Gamal El Dine  1 , Rania Yehia  2 , Randa Saied  3 , Doaa Ahmed Tolba  4
Affiliations

Corneal cross-linking guards against infectious keratitis: an experimental model

Ayah Marrie et al. Int Ophthalmol. 2023 Apr.

Abstract

Background: PACK-CXL (photo-activated chromophore for keratitis-corneal cross-linking) is an alternative option in treatment of corneal infections. It inhibits corneal melting by increasing the stromal resistance, besides the microbicidal effect of photo-activated riboflavin.

Methods: Corneal infection with Pseudomonas aeruginosa and Staph aureus bacteria was induced in 20 eyes of 10 rabbits after 6 weeks of corneal cross-linking in half of the eyes, while the other acted as control group. Clinical and corneal histopathological examination was done to evaluate the extent of inflammation, ulceration, organism penetration, and depth of corneal stromal affection.

Results: The control eyes developed severe inflammation compared to the cross-linked eyes. Corneal melting occurred in 6 eyes in the control versus none in cross-linked group. Histopathological examination showed that the inflammation was confined to the superficial part of the stroma with localization of the inflammation in the cross-linked eyes in contrast to the control eyes that showed deep infiltration.

Conclusion: PACK-CXL provides infection localization through increasing the corneal rigidity and resistance to enzymatic digestion, even in the absence of the riboflavin microbicidal role. So, early PACK-CXL is worth to be considered in the IK treatment algorithm.

Keywords: Corneal melting; Infectious keratitis; PACK-CXL; Rabbits.

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Conflict of interest statement

No conflicts of interest.

Figures

Fig. 1
Fig. 1
ASOCT of a cross-linked rabbit cornea with evident demarcation line
Fig. 2
Fig. 2
Images showing the clinical manifestations of less severity in the cross-linked eye (left) versus control eye (right) after 72 h of inception of infection
Fig. 3
Fig. 3
(H&E, X400 objective lens): A Minimal inflammatory cellular infiltrate predominantly lymphocytes with intact epithelium and minimal affection of iris and ciliary processes in an example of the cross-linked group. B Infiltrate of inflammatory cells with lymphocytic aggregation limited to the superficial stroma. C infiltrate predominantly lymphocytes underneath intact corneal epithelium with localization of inflammation in three different examples of the cross-linked group
Fig. 4
Fig. 4
(H&E × 200 & 400 objective lens) Marked corneal abrasion with dense inflammatory infiltrate with aggregation in the anterior chamber in an example of the non-cross-linked group
See this image and copyright information in PMC

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