Photodynamic Therapy for Infectious Keratitis
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REGENERATIVE MEDICINE IN OPHTHALMOLOGY (D MYUNG, SECTION EDITOR)
Photodynamic Therapy for Infectious Keratitis Diego Altamirano 1 & Jaime Martinez 1 & Katherine D. Leviste 2 & Jean Marie Parel 1,3 & Guillermo Amescua 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
ABSTRACT Purpose of Review Due to the invasive nature of the keratoplasty and the shortage of available donor tissue around the world, alternative treatments are needed for the management of progressive infectious keratitis. Recent Findings Infectious keratitis is a sight-threatening microbial infection. The prevalence of antimicrobial resistance in cases of infectious keratitis has increased the demand for fortified compounded antimicrobial drops. Even with proper medical management, severe cases of infectious keratitis can further evolve into corneal perforation, requiring surgical intervention in the form of keratoplasty to control the infectious process. In ophthalmology, photodynamic therapy (PDT) has been used for numerous applications. Summary PDT with Rose Bengal as a photosensitizer combined with green light optical irradiation (RB-PDAT) is a novel treatment with dual purpose: to arrest the infection from progressing and strengthen the collagen of the cornea. RB-PDAT may be considered as an adjunct therapy in severe cases of infectious keratitis to minimize the need for a therapeutic keratoplasty. Keywords Rose bengal photodynamic antimicrobial therapy . Cornea . Ocular surface . Infectious keratitis . Epithelial defect
Introduction Prevalence and Current Standard of Care The incidence of infectious keratitis (IK) is on the rise. In a rural region in North America, Nevitt et al. demonstrated a notable increase from 2.5 cases per 100,000 people in the 1950s to 11 cases per 100,000 people in 1980 [1]. In California, Jeng et al. observed an even greater incidence of IK at a rate of 27.6 cases per 100,000 people annually. IK occurred at a higher prevalence among contact lens wearers, where Staphylococcus aureus was identified as the most
frequently recovered organism [2]. The predominant type of microorganism may vary based on the geographic area of clinical practice. In India, the most common etiology of IK is fungal keratitis [3]. Recently, the increased prevalence of antimicrobial resistance requires the use of fortified antimicrobial drops sourced from compounding pharmacy services. However, this method of treatment subjects the ocular surface to significant toxicity [4]. Even with proper medical therapy, some cases of IK will evolve into corneal perforation and require a therapeutic penetrating keratoplasty (TPK). Corneal transplantation on an infected or inflamed ocular surface is associated with many
This article is part of the Topical Collection on Regenerative Medicine in Ophthalmology * Guillermo Amescua [email protected] Diego Altamirano [email protected]
1
Department of Ophthalmology, McKnight Vision Research Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th
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