PACK-CXL Shows Promise for Infectious Keratitis

Ophthalmologist examining patient's eyes
Ophthalmologist examining patient’s eyes
PACK-CXL yielded healing rates similar to antibiotics in patients with infectious keratitis, according to a report.

Photoactivated chromophore corneal cross-linking (PACK-CXL) may represent an alternative to antibiotics for first-line and standalone therapy in patients with early to moderate infectious keratitis of bacterial or fungal origin, according to research published in Eye and Vision.

The phase 3 clinical trial ( Identifier: NCT02717871) included 39 patients with infectious keratitis of presumed bacterial, fungal, or mixed origin. All participants were 18 years or older and hailed from 5 centers in Egypt, India, Iran, Israel, and China. They were randomly assigned to receive PACK-CXL (n=18) or antimicrobial therapy (n=21) between July 21, 2016, and March 4, 2020. The research team defined treatment success as the complete resolutions of signs of infection. 

A total of 4 patients experienced treatment failure and were subsequently excluded from the analysis: 2 in the PACK-CXL group and 2 in the antimicrobial therapy group. The overall success rates were 88.9% (16/18 patients) in the PACK-CXL group and 90.5% (19/21 patients) in the antibiotics group, according to the report. The investigators found no significant differences in time to complete corneal re-epithelialization (P =.828) between treatment groups. They reported that major complications were similar in both treatment arms.   

A limitation of the study is small cohort size. 

“When viewed from the perspective of an ophthalmologist in a developing country, PACK-CXL as a sole treatment is equally successful as medication in treating keratitis, and in most cases, PACK-CXL does so in a single, short treatment session, which is of great importance when patients may only be able to afford a single doctor visit,” according to the researchers. “Standard-of-care therapy usually requires considerably more intensive intervention by medical staff, and often, the cost burdens can be prohibitive to the patients in these regions.”

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Hafezi F, Hosny M, Shetty R, et al. PACK-CXL vs. antimicrobial therapy for bacterial, fungal, and mixed infectious keratitis. Eye and Vis. Published online January 7, 2022. doi:10.1186/s40662-021-00272-0