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Published on: March 24, 2022
Clinical Outcomes of Rose Bengal Photodynamic Therapy for Severe Infectious Keratitis
Ruth Eskenazi-Betech1, Gustavo Ortiz-Morales1, Guillermo Raul Vera-Duarte1
1Instituto de Oftalmologia Fundacion Conde de Valenciana IAP, Mexico City, Mexico.
Purpose:
To report the clinical outcomes, microbiological profile, and efficacy of Rose Bengal photodynamic therapy (RB-PDT) as adjuvant treatment in patients with severe infectious keratitis (IK).
Methods:
Prospective, noncontrolled, interventional study. Severe IK was defined as meeting ≥2 of the following: central ulcer, infiltrate ≥3 mm, presence of corneal melting or hypopyon, and lack of clinical improvement with conventional medical treatment. Clinical success was defined as avoiding a therapeutic keratoplasty (TPK).
Results:
A total of 21 eyes from 21 patients underwent RB-PDT. Clinical success was achieved in 61.9%. The mean follow-up was 9 ± 3.33 months (range: 4-15). Cultured samples were positive for 27 total microorganisms, including Fusarium spp (n = 12, 44.44%), S. epidermidis (n = 4, 14.81%), Acanthamoeba (n = 2, 7.40%), Pseudomonas spp (n = 3, 11.11%), and others. Cultured samples were grouped into bacterial (44.44%), fungal (48.14%), and polymicrobial (if cultured for multiple microorganisms, 28.57%) categories for analysis. Corneal melting (57.14%), hypopyon (57.14%), and fung-ball (38.1%) were present at the initial visit. The mean time from onset to clinical success was 89.69 ± 56.59 days. In cases of clinical success, the mean time from RB-PDT to clinical success was 46.69 ± 19.47 days. There was a total of 16 additional interventions, including evisceration (2), optical penetrating keratoplasty (5), conjunctival flap (3), amniotic membrane transplant (1), and topical losartan therapy (5). Clinical variables associated with clinical failure included diabetes and fung-ball at presentation.
Conclusions:
RB-PDT shows potential as an adjuvant therapy for managing severe infectious keratitis. TPK was avoided in 61.9% of cases.
Insights
Rose Bengal photodynamic therapy (RB-PDT) shows promise as an adjunctive treatment for severe infectious keratitis (IK). This study found RB-PDT helped avoid therapeutic keratoplasty in 61.9% of patients with severe IK.
Area of Science:
- Ophthalmology
- Microbiology
- Photodynamic Therapy
Background:
- Severe infectious keratitis (IK) poses a significant threat to vision, often requiring aggressive treatment.
- Conventional therapies may be insufficient for severe cases, necessitating novel therapeutic approaches.
Purpose of the Study:
- To evaluate the clinical outcomes and efficacy of Rose Bengal photodynamic therapy (RB-PDT) as an adjuvant treatment for severe infectious keratitis (IK).
- To analyze the microbiological profile of severe IK cases treated with RB-PDT.
Main Methods:
- A prospective, noncontrolled, interventional study was conducted on patients with severe IK.
- Severe IK was defined by specific clinical criteria including ulcer size, infiltrate depth, corneal melting, hypopyon, and lack of response to conventional treatment.
- Clinical success was defined as the avoidance of therapeutic keratoplasty (TPK).
Main Results:
- RB-PDT was administered to 21 eyes; 61.9% achieved clinical success (avoidance of TPK).
- Common causative microorganisms included Fusarium spp. (44.44%), S. epidermidis (14.81%), and Pseudomonas spp. (11.11%).
- Corneal melting and hypopyon were present in over 57% of cases at presentation; diabetes and fung-ball were associated with clinical failure.
Conclusions:
- Rose Bengal photodynamic therapy demonstrates potential as an effective adjuvant therapy for severe infectious keratitis.
- RB-PDT offers a viable option to prevent the need for therapeutic keratoplasty in a significant proportion of severe IK cases.
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