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2020 OMIG Abstract

Rose Bengal Photodynamic Antimicrobial (RB-PDAT) & Standard Antibiotic Therapy for the Treatment of Severe Infectious Keratitis

Feras Mohder, MD, Anne Kunkler, MD, Diego Altamirano, MD, Anat Galor, MD, MSPH,
Darlene Miller, DHSc, MPH, Guillermo Amescua, MD, Jean Marie Parel, PhD, FARVO
Bascom Palmer Eye Institute, University of Miami, Miami, FL

Design: A retrospective case series of four patients.

Methods: Four patients with a diagnosis of severe infectious keratitis that had treatment with standard broad-spectrum antibiotic and underwent RB-PDTA at a single academic institution during the year of 2019-2020. RB-PDAT was performed by applying a solution of rose bengal (0.1% RB in balanced salt solution) to the de-epithelialized cornea for 30 minutes, followed by irradiation with a 6 mW/cm² custom-made green LED source for 15 minutes (5.4 J/cm²).

Results: The current report includes four cases of severe infectious keratitis with culture proven of Serratia marcescens (limbus to limbus infiltrate), Pseudomonas aeruginosa (limbus to limbus infiltrate and kerato-scleritis), Pythium insidiosum (kerato-scleritis) and Mycobacterium abscessus (kerato-scleritis) in three males and one female (age range 65 to 85). At presentation, 3/4 cases had hypopyon. No patient had evidence of endophthalmitis on B-scan ultrasonography. Visual acuity (VA) ranged from LP to HM. All patients received initial treatment with topical fortified vancomycin and tobramycin that was later modified based on culture sensitivity. All cases demonstrated clinical worsening on appropriate treatment. Subsequently, all 4 patients treated with RB-PDAT and 2/4 patients had scleral debridement in OR at the time of RB-PDAT prior to consideration of therapeutic penetrating keratoplasty (TPK). One patient needed a second round of RB-PDAT therapy. Topical and/or oral antibiotic therapy were continued in all patients. Consolidation of infiltrate and near resolution of infection were noted in all patients after first round RB-PDAT. Final VA in all four patients was HM but no patients in the series required TPK.

Conclusion: RB-PDAT is a novel treatment strategy for severe infectious keratitis resistant to medical treatment that was effective at treating infection in our patients. RB-PDAT can be considered as an adjunct therapy to prevent the need for therapeutic penetrating keratoplasty.

Disclosure: N

Support: Edward D. and Janet K. Robson Foundation

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