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PACK Cross-Linking as Adjuvant Therapy Improves Clinical Outcomes in Culture-Confirmed Bacterial Keratitis
Cornea ( IF 1.9 ) Pub Date : 2022-09-01 , DOI: 10.1097/ico.0000000000002905
Asaf Achiron 1 , Omar Elhaddad 2 , Tamir Regev 3 , Yonit Krakauer 3 , Erez Tsumi 3 , Farhad Hafezi 4, 5, 6, 7 , Boris Knyazer 3
Affiliation  

Purpose: 

We recently showed the positive clinical effects of combining accelerated corneal cross-linking (PACK-CXL) with antibiotic treatment in patients with presumed bacterial keratitis. In this study, we compare the impacts of a combined PACK-CXL/standard antibiotic treatment (PACK-ABX group) with standard antibiotic treatment alone (ABX group) in patients with culture-confirmed bacterial keratitis.

Methods: 

We reviewed patients with moderate and severe bacterial keratitis and confirmed bacterial cultures. Clinical outcomes were compared for standard antibiotic treatment alone, before the initiation of PACK-CXL, and after adjuvant use of PACK-CXL.

Results: 

A total of 47 eyes of 47 patients were included: 26 eyes in the PACK-ABX group and 21 eyes in the ABX group. Pathogens, baseline demographics (besides age), and clinical parameters were similar between the 2 groups. The PACK-ABX patients had better final uncorrected visual acuity [mean difference 0.57 Logarithm of the Minimum Angle of Resolution, 95% Confidence Interval (CI): 0.16–0.99, P = 0.07] and best-corrected visual acuity (mean difference 0.70 Logarithm of the Minimum Angle of Resolution, 95% CI: 0.23–1.16, P = 0.04), shorter reepithelialization time (mean difference 9.63 days, 95% CI: 3.14–16.12, P = 0.004), and reduced number of clinic visits (mean difference 4.8 meetings, 95% CI: 1.4–8.2, P = 0.007) and need for tectonic grafts (0 vs. 33.3%, P = 0.002). A multivariate analysis controlling for age, sex, ulcer size, and Gram stain showed that PACK-ABX treatment remained significantly associated with reepithelialization time (β = 14.5, P = 0.001).

Conclusions: 

In our study, PACK-CXLs addition to the standard of care in cases of culture-proven bacterial keratitis had a positive effect on the final visual acuity and time to resolution, compared with the standard-of-care treatment.



中文翻译:

PACK 交联作为辅助治疗可改善培养证实的细菌性角膜炎的临床结果

目的: 

我们最近展示了加速角膜交联(PACK-CXL) 与抗生素治疗相结合对疑似细菌性角膜炎患者的积极临床效果。在本研究中,我们比较了 PACK-CXL/标准抗生素联合治疗(PACK-ABX 组)与单独标准抗生素治疗(ABX 组)对培养确诊的细菌性角膜炎患者的影响。

方法: 

我们回顾了患有中度和重度细菌性角膜炎的患者并证实了细菌培养。比较单独使用标准抗生素治疗、开始 PACK-CXL 之前和辅助使用 PACK-CXL 后的临床结果。

结果: 

共纳入 47 名患者的 47 只眼:PACK-ABX 组 26 只眼,ABX 组 21 只眼。两组之间的病原体、基线人口统计数据(除年龄外)和临床参数相似。PACK-ABX 患者的最终未矫正视力[平均差 0.57 最小分辨率对数,95% 置信区间 (CI):0.16–0.99,P = 0.07] 和最佳矫正视力(平均差 0.70 对数)更好最小分辨率角度的改善,95% CI:0.23–1.16,P = 0.04),更短的再上皮化时间(平均差异 9.63 天,95% CI:3.14–16.12,P = 0.004),以及减少就诊次数(平均差异差异 4.8 次会议,95% CI:1.4–8.2,P = 0.007),并且需要构造移植(0 vs. 33.3%,P = 0.002)。控制年龄、性别、溃疡大小和革兰氏染色的多变量分析表明,PACK-ABX 治疗仍然与上皮再生时间显着相关(β = 14.5,P = 0.001)。

结论: 

在我们的研究中,与标准护理治疗相比,在培养证明的细菌性角膜炎病例中,除了标准护理之外,PACK-CXL 对最终视力和恢复时间有积极影响。

更新日期:2022-08-09
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