Photoactivated chromophore corneal cross-linking (PACK-CXL) for treatment of severe keratitis.

Purpose: To report our experience with photoactivated chromophore corneal cross-linking (PACK-CXL) for treating keratitis patients.

Methods: This retrospective study consists of 27 eyes of 26 patients with infectious keratitis treated with PACK-CXL at the Helsinki University Hospital between 2009 and 2017. Patients were treated with antibiotics/antifungal medications and underwent PACK-CXL procedure due to lack of clinical response or severe corneal melts. For twenty patients, amniotic membrane transplant (AMT) was done during the same day. Follow-up after cross-linking ranged from 1 week to 12 months.

Results: Sixteen infections were related to contact lens wear. Of the 19 eyes showing positive culture, the predominant micro-organism was Pseudomonas aeruginosa (9 cases). The average re-epithelization time was 13 days and in 15 cases (56%) the re-epithelization occurred within one week. In 26 eyes, visual acuity increased and seven patients (26%) had a final visual acuity more or equal to 0.5 (20/40) Snellen.

Conclusions: PACK-CXL seems to be a safe and potential option for treating patient with infectious keratitis who do not respond to antibiotic therapy.