Department of Ophthalmology, Örebro University Hospital, 701 85 Örebro, Sweden.
Graefes Arch Clin Exp Ophthalmol. 2012 Jan;250(1):95-102. doi: 10.1007/s00417-011-1754-1. Epub 2011 Aug 27.
The aim of this work as to investigate the photochemical interaction used in corneal crosslinking (CXL) as the primary therapy for bacterial keratitis.
A prospective non-randomized study was conducted including 16 patients with a clinical diagnosis of bacterial keratitis. No patient had any prior antibiotic treatment for the current infection. Photography and microbial culturing of the infected cornea were performed. Riboflavin was topically administered for 20 min and ultraviolet light (UVA) exposure settings for treatment of keratoconus were used. After the procedure, clinical examinations were done at least once daily until signs of improvement had been established. The frequency of examinations was thereafter reduced. Antibiotic therapy was initiated if infectious progression was suspected. The trial was registered at ISCRTN.org (no: 21432643).
All eyes responded to the photochemical treatment with improvement in symptoms and signs of reduced inflammation. Epithelial healing was achieved in all cases. Antibiotic administration was necessary in two cases. One patient required a human amniotic membrane transplant.
This trial illustrates that photosensitization of riboflavin using UVA at 365 nm has the potential to induce healing in patients with microbial keratitis. The results from the treatment of these 16 patients with corneal ulcers indicate that UVA-riboflavin photochemical therapy merits a controlled study in order to assess its efficacy and safety compared to antibiotics.
本研究旨在探讨光化学相互作用在角膜交联（CXL）中的应用，CXL 是细菌性角膜炎的主要治疗方法。
这是一项前瞻性非随机研究，共纳入 16 例临床诊断为细菌性角膜炎的患者。所有患者当前感染均未接受过任何抗生素治疗。对感染角膜进行摄影和微生物培养。局部滴注核黄素 20 分钟，采用治疗圆锥角膜的紫外线 A（UVA）光暴露参数进行治疗。治疗后，至少每天进行一次临床检查，直到炎症改善迹象确立。此后减少检查频率。如果怀疑感染进展，则开始使用抗生素治疗。本试验在 ISCRTN.org 注册（编号：21432643）。
所有患者的光化学治疗均有效，症状和炎症体征均得到改善。所有病例均实现上皮愈合。有两例需要使用抗生素。一例患者需要进行人羊膜移植。
本研究表明，365nm 紫外线 A 对核黄素的光敏化作用具有诱导微生物性角膜炎患者愈合的潜力。对这 16 例角膜溃疡患者的治疗结果表明，UVA-核黄素光化学疗法值得进行对照研究，以评估其与抗生素相比的疗效和安全性。
