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2021 OMIG Abstract
Rose Bengal Photodynamic Antimicrobial Therapy: A Review of The Long-Term Clinical and Surgical Outcomes Following Keratoplasty
Paula A. Sepulveda-Beltran1,2, Harry Levine1, Diego S. Altamirano1, Heather Durkee2, Roger Leblanc3, Darlene Miller4, Jean-Marie Parel2, Guillermo Amescua1,2
1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida;
2Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, Department of Ophthalmology, Miami, Florida; 3Department of Chemistry, University of Miami, Coral Gables, Florida; 4Ocular Microbiology Laboratory, Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida
Purpose: To evaluate the long-term clinical outcomes of Rose Bengal Photodynamic Antimicrobial Therapy (RB-PDAT) for infectious keratitis. Secondarily, to evaluate the surgical outcomes of individuals that underwent keratoplasty after RB-PDAT.
Methods: Retrospective chart review of 32 eyes from 31 consecutive individuals with infectious keratitis refractive to standard medical therapy that underwent RB-PDAT at the Bascom Palmer Eye Institute between January 2016 and July 2020. To perform RB-PDAT, a solution of Rose Bengal (0.1% RB in 0.9% Sodium Chloride) was instilled into the de-epithelialized cornea for 30 minutes, followed by irradiation with a custom-made green LED source for 15 minutes at 5.4 J/cm2. Graft survival was evaluated using Kaplan Meier curves with log-ranks in individuals that underwent keratoplasty after RB-PDAT.
Results: The mean age of the study population was 53±18.0 years. 70.9% were female; 51.6% self-identified as non-Hispanic White; and 41.9% as Hispanic. Mean follow-up time was 28.0±14.4 months. Risk factors included contact lens use (78.1%), history of infectious keratitis (18.7%), dry eye (16.7%). Cultures were positive for Acanthamoeba (53.1%), Fusarium (13.3%), Pseudomonas (6.2%). 21.8% of individuals with Acanthamoeba infection received concomitant Miltefosine. Clinical resolution was achieved in 75% of individuals with a mean time of 2.72 ±1.85 months; 75% underwent keratoplasty after RB-PDAT; 21.8% required Therapeutic Penetrating Keratoplasty (T.PKP) 0.89±0.95 months after RB-PDAT, and 34.3% required Optical Penetrating Keratoplasty (OPK) 9.29±4.78 months after RB-PDAT. At 2 years, the overall probability of graft survival was 78%. Graft failure rate was 12.5%.
Conclusions: RB-PDAT is a potential adjunct therapy for infectious keratitis that may reduce the need for therapeutic keratoplasty with good visual outcomes.
Disclosure: P (JMP, GA, HD); N (PSB, HL, DA, RL, DM)
Support: Supported by the Edward D. and Janet K. Robson Foundation (Tulsa, OK); the Florida Lions Eye Bank and the Beauty of Sight Foundation (Miami, FL); NIH Center Core Grant P30EY14801 (Institutional); the Henri and Flore Lesieur Foundation (Chicago, IL)(J.-M. Parel).
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