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Subspecialties Cornea / Ocular Surface, Cornea / Ocular Surface

Time to PACK?

At a Glance

  •  Corneal crosslinking (CXL)is traditionally used to stabilize corneal ectasia and keratoconus progression
  • Photoactivated chromophore for infectious keratitis-crosslinking (PACK-CXL) is currently being studied as a potential treatment modality for infectious keratitis
  • Here, we overview current PACK-CXL research for bacterial keratitis, and consider the future potential for managing the disease.

Corneal crosslinking (CXL) initially came to prominence over three decades ago as a potential treatment modality to stabilize corneal ectasia and halt the progression of keratoconus. Its components – a photoactivated chromophore (riboflavin) and ultraviolet (UV) light – act on the corneal stroma, the collagen-rich central layer that comprises 90 percent of corneal thickness and contributes the bulk of corneal biomechanical stability. Effective stromal crosslinking strengthens corneal biomechanics by facilitating the formation of corneal fibrillar covalent bonds, which alters the biochemical structure of corneal collagen fibers and increases stromal resistance to enzymatic degradation or keratolysis.

As researchers investigate ways to further improve the CXL procedure, newer potential applications of crosslinking are also under investigation. Transfusion medicine has harnessed the antimicrobial properties of crosslinking, and treats blood concentrates with crosslinking procedures to inactivate any existing microbial pathogens and decrease pathogen load.  This advance has spurred the concept of using crosslinking in the management of infections, specifically corneal infections – namely, photoactivated chromophore for infectious keratitis-crosslinking (PACK-CXL) (a term that has been coined to differentiate from conventional CXL). Here, we will review what is currently known about PACK-CXL, and discuss the future therapeutic possibilities for the procedure.

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About the Author

Sneha Konda and Bala Ambati

Sneha Konda is a fourth year medical student at Texas A&M College of Medicine, College Station, TX, USA.
Bala Ambati is Professor of Ophthalmology, Moran Eye Center, University of Utah, UT, USA.

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