Corneal collagen cross-linking for bacterial infectious keratitis

Area of Science:

• Ophthalmology
• Infectious Diseases
• Medical Therapies

Background:

• Infectious keratitis is a serious corneal infection with various causes including bacteria.
• Photoactivated chromophore for collagen cross-linking (PACK-CXL) is an emerging therapy for corneal conditions.
• PACK-CXL is being explored as a treatment for infectious keratitis.

Purpose of the Study:

• To compare the effectiveness and safety of PACK-CXL plus standard therapy versus standard therapy alone for bacterial keratitis.

Main Methods:

• Systematic search of multiple databases including CENTRAL, MEDLINE, Embase, PubMed, LILACS, ClinicalTrials.gov, and ICTRP.
• Inclusion of randomized controlled trials (RCTs), quasi-RCTs, and controlled clinical trials (CCTs).
• Independent selection of studies, risk of bias assessment, and data extraction by two reviewers.

Main Results:

• Three trials (2 RCTs, 1 quasi-RCT) with 59 participants were included.
• Evidence is very uncertain regarding PACK-CXL's effectiveness for re-epithelialization and complete healing (RR 1.53, 95% CI 0.88 to 2.66).
• Low certainty evidence suggests no significant difference in treatment failure (RR 0.50, 95% CI 0.05 to 4.98) and no reported adverse events at 14 days.

Conclusions:

• Current evidence on PACK-CXL for bacterial keratitis is of low certainty and heterogeneous.
• Five ongoing RCTs with 1136 participants may provide more definitive answers.
• Future research should include subgroup analyses and establish a core outcomes set.