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2023 OMIG Abstract

Adjunctive treatment with Rose Bengal Photodynamic Antimicrobial Therapy for Patients with Progressive Infectious Keratitis: Outcomes of the First 100 Patients

Jordan Huang¹; Alejandro Arboleda²; Heather Durkee²; Mariela C. Aguilar²; Andrea Naranjo^2-3; Juan Carlos Navia¹; Esdras Arrieta²; Miguel Lugo¹; Jaime D. Martinez^1,2; Anat Galor^1,4; Guillermo Amescua^1,2; Harry W. Flynn, Jr¹; Darlene Miller²; Jean-Marie Parel<sup>1,2

1</sup>Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami FL; ²Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami FL; ³Anne Bates Leach Eye Hospital, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami FL; ⁴Surgical and Research Services, Miami Veterans Administration Medical Center, Miami, FL

Purpose: To report clinical outcomes of rose bengal photodynamic antimicrobial therapy (RB-PDAT) as an adjunct treatment for severe, progressive, infectious keratitis.

Methods: Patients with progressive, infectious keratitis recalcitrant to standard medical treatment underwent RB-PDAT at Bascom Palmer Eye Institute from January 2016 to July 2023. RB-PDAT was performed using rose Bengal 0.1-0.2% in balanced salt solution to the de-epithelialized cornea for 30 minutes, followed by irradiation with a 6mW/cm2 custom-made green light LED source for 15 minutes (5.4J/cm²). The primary outcome was frequency of RB-PDAT success, defined as avoidance of therapeutic penetrating keratoplasty (TPK).

Results: A total of one hundred and three patients underwent RB-PDAT at Bascom Palmer Eye Institute. After exclusion criteria, 96 were included in this study (42 males, 54 females). Ages ranged from 15 to 87 years old. Acanthamoeba was the most prevalent microbe at 48% (46/96), followed by pseudomonas at 14% (13/96), and fusarium at 11% (11/96). Main clinical risk factor for keratitis was contact lens wear at 61% (59/96). Successful RB-PDAT (avoidance of TPK) was achieved in 76% (73/96) of cases. RB-PDAT failed in 24% (23/96) of cases. Average time to clinical resolution following RB-PDAT was 184 days ± 297 days. In patients that underwent a TPK/OPK/DALK, corneal transplant outcomes were as follows: successful transplant (defined as a clear cornea on last follow-up exam) was achieved in 72% (39/54) of patients, failed transplant was found in 22% (12/54) of patients, and reinfection occurred in 6% (3/54) of patients. Amongst patients that received TPK, the average follow-up time after rose Bengal was 400 ± 553 days.

Conclusions: The current study results indicate that RB-PDAT using 0.1-0.2% RB, 5.4 J/cm², and green light exposure shows great promise as a non-invasive adjunct treatment modality for severe, progressive infectious keratitis that is resistant to standard medical therapy. Further, amongst patients that required a TPK, reinfection rate remained low, which may indicate further advantages to the use of RB-PDAT.

Disclosure: N

Support: Edward D. and Janet K. Robson Foundation, Florida Lions Eye Bank and the Beauty of Sight Foundation (Olsen, Hildebrant, Urs, and Furtado); NIH Center Grant P30EY14801, Research to Prevent Blindness, Henri and Flore Lesieur Foundation (Parel).

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