Hung Jia-Horung, Lee Chaw-Ning, Hsu Huai-Wen, Ng I-Son, Wu Chi-Jung, Yu Chun-Keung, Lee Nan-Yao, Chang Yun, Wong Tak-Wah
Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan.
Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan.
Pharmaceutics. 2021 Nov 26;13(12):2011. doi: 10.3390/pharmaceutics13122011.
Fungal keratitis is a serious clinical infection on the cornea caused by fungi and is one of the leading causes of blindness in Asian countries. The treatment options are currently limited to a few antifungal agents. With the increasing incidence of drug-resistant infections, many patients fail to respond to antibiotics. Riboflavin-mediated corneal crosslinking (similar to photodynamic therapy (PDT)) for corneal ectasia was approved in the US in the early 2000s. Current evidence suggests that PDT could have the potential to inhibit fungal biofilm formation and overcome drug resistance by using riboflavin and rose bengal as photosensitizers. However, only a few clinical trials have been initiated in anti-fungal keratitis PDT treatment. Moreover, the removal of the corneal epithelium and repeated application of riboflavin and rose bengal are required to improve drug penetration before and during PDT. Thus, an improvement in trans-corneal drug delivery is mandatory for a successful and efficient treatment. In this article, we review the studies published to date using PDT against fungal keratitis and aim to enhance the understanding and awareness of this research area. The potential of modifying photosensitizers using nanotechnology to improve the efficacy of PDT on fungal keratitis is also briefly reviewed.
真菌性角膜炎是由真菌引起的角膜严重临床感染，是亚洲国家失明的主要原因之一。目前的治疗选择仅限于少数抗真菌药物。随着耐药性感染的发病率不断上升，许多患者对抗生素没有反应。21世纪初，核黄素介导的角膜交联（类似于光动力疗法（PDT））用于治疗角膜扩张在美国获得批准。目前的证据表明，通过使用核黄素和孟加拉玫瑰红作为光敏剂，光动力疗法可能具有抑制真菌生物膜形成和克服耐药性的潜力。然而，只有少数临床试验已在抗真菌性角膜炎光动力疗法治疗中开展。此外，在光动力疗法之前和期间，需要去除角膜上皮并反复应用核黄素和孟加拉玫瑰红以提高药物渗透性。因此，改善角膜药物递送对于成功和有效的治疗是必不可少的。在本文中，我们回顾了迄今为止发表的使用光动力疗法治疗真菌性角膜炎的研究，旨在增进对该研究领域的理解和认识。还简要回顾了使用纳米技术修饰光敏剂以提高光动力疗法治疗真菌性角膜炎疗效的潜力。
