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2020 OMIG Abstract

Evaluation of Rose Bengal Photodynamic Antimicrobial Therapy as an Adjunctive Treatment for Severe Keratitis

Wirley Alves de Mendonça Júnior, MD1, Talita Trevizani Rocchetti, PhD1, Denise de Freitas, MD, PhD1,
JarbasCaiado de Castro Neto, PhD2, Ana Luisa Hofling-Lima, MD, PhD1

1Ophthalmology Department, Federal University of São Paulo-São Paulo;
2Physics Institute, University of São Paulo - São Carlos, Sao Paulo, Brasil

Purpose: To evaluate the inclusion of rose bengal photodynamic antimicrobial therapy (RB-PDAT) for treatment of patients with severe infectious keratitis.

Methods: Four patients with severe keratitis (one methicillin-resistant Staphylococcus aureus (MRSA), one methicillin-susceptible S. aureus (MSSA), one Moraxella spp. and one Fusarium solani) not responsive to standard medical care were treated with RB-PDAT. The areas of epithelial defect were 95, 90, 24.44 and 1mm2 while the stromal opacification areas were 95, 40, 24.44 and 6mm2, respectively. The lengths of standard medical treatment prior to the procedure were 7, 1, 18 and 21 days, respectively. RB-PDAT was performed by applying a solution of rose bengal 0.1% in balanced salt solution to the de-epithelialized cornea for 30 minutes (one drop every three minutes), followed by irradiation with a 7.15 mW/cm2 custom-made green LED source for 15 minutes (6.43 J/cm2). In order to evaluate RB-PDAT activity against the infecting microorganism, tests were performed “in vitro” as well.

Results: All eyes had clinical resolution of infection in 40 (MRSA), 16 (MSSA), 102 (Moraxella spp.) and 67 (F. solani) days after RB-PDAT. Patients with Moraxella spp. and F. solani keratitis required a second treatment, 34 and 20 days after the first procedure, respectively. Patient with MSSA infection was the only who had a diffuse thin cornea (480 micra) due to a very compromised ocular surface and had a small corneal perforation 9 days after the procedure, which was managed with cyanoacrylate glue. None of the cases needed therapeutic keratoplasty.

Conclusion: RB-PDAT can be considered as an adjunctive therapy in cases of severe and progressive keratitis despite standard medical care, especially to avoid therapeutic keratoplasty.

Disclosure: N



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