Hafezi Farhad, Messerli Jürg, Torres-Netto Emilio A, Lu Nan-Ji, Aydemir M Enes, Hafezi Nikki L, Hillen Mark
ELZA Institute AG, Bahnhofstrasse 15, 8001, Zurich, Switzerland.
Laboratory of Ocular Cell Biology, Center for Applied Biotechnology and Molecular Medicine, University of Zurich, Zurich, Switzerland.
Eye Vis (Lond). 2025 Jan 3;12(1):2. doi: 10.1186/s40662-024-00420-2.
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.
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/cm) and rose bengal/green light (522 nm) irradiation (5.4 J/cm) 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 Acanthamoeba cysts. The patient currently awaits penetrating keratoplasty.
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.
棘阿米巴角膜炎（AK）是最难治疗的角膜感染性疾病，传统治疗方法往往无效。虽然用于角膜炎-角膜交联（PACK-CXL）的核黄素/紫外线A光活化发色团在治疗细菌性和真菌性角膜炎方面已取得成功，并且孟加拉玫瑰红/绿光的PACK-CXL在真菌性角膜炎治疗中已显示出前景，但这两种方法均未被证明能有效根除AK。本病例研究探讨了一种在单一手术中同时使用核黄素/紫外线A和孟加拉玫瑰红/绿光的新型联合同期治疗方法。
一名44岁的患者，左眼患有活动性AK，根据美国眼科学会（AAO）指南，在接受了10个月的传统治疗后无反应，在单一环境中接受了同期序贯PACK-CXL治疗，先后进行核黄素/紫外线A（365nm）照射（10J/cm）和孟加拉玫瑰红/绿光（522nm）照射（5.4J/cm）。由于炎症和感染的持续迹象，该手术重复了两次。经过三次联合同期PACK-CXL治疗后，患者的角膜转变为静止性瘢痕，眼痛、畏光、流泪和眼睑痉挛等症状消失。共焦显微镜检查未发现可检测到的棘阿米巴囊肿。该患者目前正在等待穿透性角膜移植术。
核黄素/紫外线A和孟加拉玫瑰红/绿光PACK-CXL同期联合治疗有效地治疗了一名确诊的对传统药物治疗耐药的AK患者，这表明在单一手术中使用两种发色团可能是未来治疗AK的一种选择。
