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Open Access 03-01-2025 | Keratitis | Case report

Same-session dual chromophore riboflavin/UV-A and rose bengal/green light PACK-CXL in Acanthamoeba keratitis: a case report

Authors: Farhad Hafezi, Jürg Messerli, Emilio A. Torres-Netto, Nan-Ji Lu, M. Enes Aydemir, Nikki L. Hafezi, Mark Hillen

Published in: Eye and Vision | Issue 1/2025

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Abstract

Background

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.

Case presentation

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/cm2) and rose bengal/green light (522 nm) irradiation (5.4 J/cm2) 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.

Conclusions

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.
Appendix
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Metadata
Title
Same-session dual chromophore riboflavin/UV-A and rose bengal/green light PACK-CXL in Acanthamoeba keratitis: a case report
Authors
Farhad Hafezi
Jürg Messerli
Emilio A. Torres-Netto
Nan-Ji Lu
M. Enes Aydemir
Nikki L. Hafezi
Mark Hillen
Publication date
03-01-2025
Publisher
BioMed Central
Published in
Eye and Vision / Issue 1/2025
Electronic ISSN: 2326-0254
DOI
https://doi.org/10.1186/s40662-024-00420-2