Purpose

To evaluate the intermediate term clinical outcomes of Rose Bengal Photodynamic Antimicrobial Therapy (RB-PDAT) for infectious keratitis. Secondarily, to evaluate the surgical outcomes of individuals that underwent optical keratoplasty after RB-PDAT.

Design

Retrospective cohort study.

Methods

Retrospective chart review of 31 eyes from 30 consecutive individuals with infectious keratitis refractory to standard medical therapy who underwent RB-PDAT at the Bascom Palmer Eye Institute between January 2016 and July 2020. Data collected included demographics, risk factors for infectious keratitis, microbiological diagnosis, Best Spectacle-Corrected Visual Acuity (BCVA), clinical outcomes after RB-PDAT and complication rates post-keratoplasty. RB-PDAT was performed as described in previous studies. Graft survival was evaluated using Kaplan Meier curves with log-ranks in individuals that underwent keratoplasty after RB-PDAT.

Results

Mean age of the study population was 53±18.0 years. 70% were female; 53.3% self-identified as non-Hispanic White; 43.3% as Hispanic. Mean follow-up time was 28.0±14.4 months. Risk factors included contact lens use (80.6%), history of infectious keratitis (19.3%), and ocular surface disease (16.1%). Cultures were positive for Acanthamoeba (51.6%), Fusarium (12.9%), and Pseudomonas (6.5%). 22.5% of individuals with Acanthamoeba infection were treated with concomitant Miltefosine. Clinical resolution was achieved in 77.4% of individuals on average 2.72±1.85 months after RB-PDAT with 22.5% requiring therapeutic penetrating keratoplasties and 54.8% subsequently requiring optical penetrating keratoplasties. At 2 years, the overall probability of graft survival was 78.7% and the graft failure rate was 21.3%.

Conclusion

RB-PDAT is a potential adjunct therapy for infectious keratitis that may reduce the need for a therapeutic penetrating keratoplasty. Cases that undergo keratoplasty after RB-PDAT may have a higher probability of graft survival at one year postoperatively.

中文翻译：

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玫瑰红光动力抗菌疗法：中期临床和手术结果回顾

目的

评估孟加拉玫瑰光动力抗菌疗法 (RB-PDAT) 治疗感染性角膜炎的中期临床结果。其次，评估在 RB-PDAT 后接受光学角膜移植术的个体的手术结果。

设计

回顾性队列研究。

方法

对 2016 年 1 月至 2020 年 7 月期间在 Bascom Palmer 眼科研究所接受 RB-PDAT 的 30 名标准药物治疗难治性感染性角膜炎患者的 31 只眼进行回顾性图表审查。收集的数据包括人口统计学、感染性角膜炎的危险因素、微生物学诊断、最佳眼镜矫正视力 (BCVA)、RB-PDAT 后的临床结果和角膜移植术后的并发症发生率。RB-PDAT 如先前研究中所述进行。在 RB-PDAT 后接受角膜移植术的个体中，使用 Kaplan Meier 曲线和对数秩评估移植物存活率。

结果

研究人群的平均年龄为 53±18.0 岁。70%为女性；53.3% 的人自认为是非西班牙裔白人；43.3% 为西班牙裔。平均随访时间为 28.0±14.4 个月。危险因素包括使用隐形眼镜 (80.6%)、感染性角膜炎病史 (19.3%) 和眼表疾病 (16.1%)。培养物对棘阿米巴(51.6%)、镰刀菌(12.9%) 和假单胞菌(6.5%) 呈阳性。22.5% 的人患有棘阿米巴感染用伴随的米替福新治疗。在 RB-PDAT 后平均 2.72±1.85 个月内，77.4% 的个体实现了临床解决，其中 22.5% 需要治疗性穿透性角膜移植术，54.8% 随后需要光学穿透性角膜移植术。2 年时，移植物存活的总体概率为 78.7%，移植物失败率为 21.3%。

结论

RB-PDAT 是感染性角膜炎的潜在辅助疗法，可减少对治疗性穿透性角膜移植术的需求。在 RB-PDAT 后接受角膜移植术的病例术后一年的移植物存活率可能更高。