Same-session dual chromophore riboflavin/UV-A and rose bengal/green light PACK-CXL in Acanthamoeba keratitis: a case report
Abstract Background Acanthamoeba keratitis (AK) is the most challenging corneal infection to treat, with conventional therapies often proving ineffective. While photoactivated chromophore for keratitis-corneal cross-linking (PACK-CXL) with riboflavin/UV-A has shown success in treating bacterial and...
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BMC
2025-01-01
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| Series: | Eye and Vision |
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| Online Access: | https://doi.org/10.1186/s40662-024-00420-2 |
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| author | Farhad Hafezi Jürg Messerli Emilio A. Torres-Netto Nan-Ji Lu M. Enes Aydemir Nikki L. Hafezi Mark Hillen |
| author_facet | Farhad Hafezi Jürg Messerli Emilio A. Torres-Netto Nan-Ji Lu M. Enes Aydemir Nikki L. Hafezi Mark Hillen |
| author_sort | Farhad Hafezi |
| collection | DOAJ |
| description | Abstract Background Acanthamoeba keratitis (AK) is the most challenging corneal infection to treat, with conventional therapies often proving ineffective. While photoactivated chromophore for keratitis-corneal cross-linking (PACK-CXL) with riboflavin/UV-A has shown success in treating bacterial and fungal keratitis, and PACK-CXL with rose bengal/green light has demonstrated promise in fungal keratitis, neither approach has been shown to effectively eradicate AK. This case study explores a novel combined same-session treatment approach using both riboflavin/UV-A and rose bengal/green light in a single procedure. Case presentation A 44-year-old patient with active AK in the left cornea, unresponsive to 10 months of conventional treatment according to American Academy of Ophthalmology (AAO) guidelines, was treated using same-session sequential PACK-CXL with riboflavin/UV-A (365 nm) irradiation (10 J/cm2) and rose bengal/green light (522 nm) irradiation (5.4 J/cm2) in a single setting. The procedure was repeated twice due to persistent signs of inflammation and infection. After three combined same-session PACK-CXL treatments, the patient’s cornea converted to a quiescent scar, and symptoms of ocular pain, photophobia, epiphora, and blepharospasm resolved. Confocal microscopy revealed no detectable A canthamoeba cysts. The patient currently awaits penetrating keratoplasty. Conclusions The same-session combination of riboflavin/UV-A and rose bengal/green light PACK-CXL effectively treated a patient with confirmed AK that was resistant to conventional medical therapy, suggesting that using two chromophores in a single procedure may represent a future treatment alternative for AK. |
| format | Article |
| id | doaj-art-59a3054343ce4d509c791cc7a00862b6 |
| institution | Kabale University |
| issn | 2326-0254 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Eye and Vision |
| spelling | doaj-art-59a3054343ce4d509c791cc7a00862b62025-01-05T12:08:54ZengBMCEye and Vision2326-02542025-01-011211610.1186/s40662-024-00420-2Same-session dual chromophore riboflavin/UV-A and rose bengal/green light PACK-CXL in Acanthamoeba keratitis: a case reportFarhad Hafezi0Jürg Messerli1Emilio A. Torres-Netto2Nan-Ji Lu3M. Enes Aydemir4Nikki L. Hafezi5Mark Hillen6ELZA Institute AGDepartment of Ophthalmology, University Hospital BaselELZA Institute AGELZA Institute AGELZA Institute AGELZA Institute AGELZA Institute AGAbstract Background Acanthamoeba keratitis (AK) is the most challenging corneal infection to treat, with conventional therapies often proving ineffective. While photoactivated chromophore for keratitis-corneal cross-linking (PACK-CXL) with riboflavin/UV-A has shown success in treating bacterial and fungal keratitis, and PACK-CXL with rose bengal/green light has demonstrated promise in fungal keratitis, neither approach has been shown to effectively eradicate AK. This case study explores a novel combined same-session treatment approach using both riboflavin/UV-A and rose bengal/green light in a single procedure. Case presentation A 44-year-old patient with active AK in the left cornea, unresponsive to 10 months of conventional treatment according to American Academy of Ophthalmology (AAO) guidelines, was treated using same-session sequential PACK-CXL with riboflavin/UV-A (365 nm) irradiation (10 J/cm2) and rose bengal/green light (522 nm) irradiation (5.4 J/cm2) in a single setting. The procedure was repeated twice due to persistent signs of inflammation and infection. After three combined same-session PACK-CXL treatments, the patient’s cornea converted to a quiescent scar, and symptoms of ocular pain, photophobia, epiphora, and blepharospasm resolved. Confocal microscopy revealed no detectable A canthamoeba cysts. The patient currently awaits penetrating keratoplasty. Conclusions The same-session combination of riboflavin/UV-A and rose bengal/green light PACK-CXL effectively treated a patient with confirmed AK that was resistant to conventional medical therapy, suggesting that using two chromophores in a single procedure may represent a future treatment alternative for AK.https://doi.org/10.1186/s40662-024-00420-2Acanthamoeba keratitisPACK-CXLRiboflavinUV-ARose bengalGreen light |
| spellingShingle | Farhad Hafezi Jürg Messerli Emilio A. Torres-Netto Nan-Ji Lu M. Enes Aydemir Nikki L. Hafezi Mark Hillen Same-session dual chromophore riboflavin/UV-A and rose bengal/green light PACK-CXL in Acanthamoeba keratitis: a case report Eye and Vision Acanthamoeba keratitis PACK-CXL Riboflavin UV-A Rose bengal Green light |
| title | Same-session dual chromophore riboflavin/UV-A and rose bengal/green light PACK-CXL in Acanthamoeba keratitis: a case report |
| title_full | Same-session dual chromophore riboflavin/UV-A and rose bengal/green light PACK-CXL in Acanthamoeba keratitis: a case report |
| title_fullStr | Same-session dual chromophore riboflavin/UV-A and rose bengal/green light PACK-CXL in Acanthamoeba keratitis: a case report |
| title_full_unstemmed | Same-session dual chromophore riboflavin/UV-A and rose bengal/green light PACK-CXL in Acanthamoeba keratitis: a case report |
| title_short | Same-session dual chromophore riboflavin/UV-A and rose bengal/green light PACK-CXL in Acanthamoeba keratitis: a case report |
| title_sort | same session dual chromophore riboflavin uv a and rose bengal green light pack cxl in acanthamoeba keratitis a case report |
| topic | Acanthamoeba keratitis PACK-CXL Riboflavin UV-A Rose bengal Green light |
| url | https://doi.org/10.1186/s40662-024-00420-2 |
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