PACK-CXL Similar to Antimicrobial Therapy for Early Infectious Corneal Ulcers

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. 

Researchers conducted a prospective, interventional, multicenter, randomized, controlled phase-3 clinical trial (Swiss PACK-CXL Multicenter Trial for the Treatment of Infectious Keratitis; ClinicalTrials.gov 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. 

Reference

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.