The following article is a part of conference coverage from the American Academy of Ophthalmology 2020, being held virtually from November 13 to 15, 2020. The team at Ophthalmology Advisor will be reporting on the latest news and research conducted by leading experts in ophthalmology. Check back for more from the AAO 2020.

Both photoactivated chromophore for infectious keratitis-corneal cross linking (PACK-CXL) and antimicrobial medication demonstrated similar rates of corneal re-epithelialization in early infectious corneal ulcers, according to clinical trial results presented at the American Academy of Ophthalmology 2020 annual meeting, held virtually November 13 to 15, 2020. 

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Researchers conducted a prospective, interventional, multicenter, randomized, controlled phase-3 clinical trial (Swiss PACK-CXL Multicenter Trial for the Treatment of Infectious Keratitis; identifier NCT02717871) to analyze the time to corneal epithelialization with first-line PACK-CXL treatment for early infectious corneal ulcers compared with the current standard of care, antimicrobial therapy.

Trial inclusion criteria were both infiltrates and early ulcers up to 4 mm in diameter and 300 µm in depth. Participants (n=42) were randomly assigned into 1 of 2 groups: PACK-CXL only or antimicrobial medication only. Total energy of the PACK-CXL group was 5.4 or 7.2 J/cm2, and corneal re-epithelialization times were compared. 

The most commonly identified fungal pathogens were gram-positive cocci. Participants with fungal infections demonstrated worse visual acuity at both presentation and discharge. No re-epithelialization differences were noted between groups (P =.791). 

“Even with a tendency for longer healing, 89% of eyes treated with PACK-CXL healed without the use of antimicrobial therapy, compared [with] 93% in the medication (antimicrobial) only group,” the researchers concluded. 

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures. 


Torres Netto EA, Shetty R, Knyazer B, et al. PACK-CXL for treating infectious keratitis: final results of the prospective randomized controlled multicenter trial. Presented at: American Academy of Ophthalmology 2020 Annual Meeting; November 13-15, 2020. Abstract PO076.

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