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Ultraviolet light A (UVA) photoactivation of riboflavin as a potential therapy for infectious keratitis
Örebro University, School of Health and Medical Sciences.
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Place, publisher, year, edition, pages
Örebro: Örebro universitet , 2011. , p. 70
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 63
National Category
Medical and Health Sciences Surgery
Research subject
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-20130ISBN: 978-91-7668-834-2 (print)OAI: oai:DiVA.org:oru-20130DiVA, id: diva2:450387
Public defence
2011-12-16, Wilandersalen, Universitetssjukhuset, Örebro, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2011-10-20 Created: 2011-10-20 Last updated: 2017-10-17Bibliographically approved
List of papers
1. Infectious keratitis treated with corneal crosslinking
Open this publication in new window or tab >>Infectious keratitis treated with corneal crosslinking
2010 (English)In: Cornea, ISSN 0277-3740, E-ISSN 1536-4798, Vol. 29, no 12, p. 1353-1358Article in journal (Refereed) Published
Abstract [en]

Purpose: To describe 7 eyes with severe infectious keratitis treated using collagen crosslinking (CXL) with riboflavin. Materials and Methods: Seven eyes of 6 patients with severe infectious keratitis were treated with corneal crosslinking. Three patients were contact lens users. Symptom duration before CXL ranged between 0 and 7 days. Corneal melting was present in all cases. Photodocumentation of the keratitis was carried out and repeated at follow-up. All but 1 patient received topical antibiotic treatment in addition to the CXL treatment. CXL was conducted according to the standardized protocol for keratoconus. Results: In all but 1 eye, patients experienced improvement in symptoms within 24 hours. Two patients reported no symptoms whatsoever at this time. Corneal melting was arrested and complete epithelialization was achieved in all cases. In the 2 eyes with hypopyon, this regressed completely within 2 days after the CXL. Follow-up ranged between 1 and 6 months. Discussion: Our experience based on the above and other cases suggest that CXL could be an effective tool in battling difficult cases of infectious keratitis. This treatment could present many advantages but will need further investigation.

Keywords
CXL, crosslinking, riboflavin, keratitis, UV-A, ultraviolet A, corneal melting
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-20751 (URN)10.1097/ICO.0b013e3181d2de91 (DOI)000284580000003 ()
Available from: 2012-01-09 Created: 2012-01-09 Last updated: 2017-12-08Bibliographically approved
2. Evaluation of antibacterial efficacy of photo-activated riboflavin using ultraviolet light (UVA)
Open this publication in new window or tab >>Evaluation of antibacterial efficacy of photo-activated riboflavin using ultraviolet light (UVA)
2010 (English)In: Graefe's Archives for Clinical and Experimental Ophthalmology, ISSN 0721-832X, E-ISSN 1435-702X, Vol. 248, no 2, p. 207-212Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: To evaluate the antibacterial efficacy of photo-activated riboflavin using Ultraviolet A (UVA) on three bacterial strains commonly detected in keratitis. METHODS: Three bacterial strains (Staphylococcus epidermidis, Staphylococcus aureus and Pseudomonas aeruginosa) were cultured on blood/hematin-agar plates and dispersed in PBS. Dispersion was done of 10 microl of bacterial stock-solutions in 90 microl of RPMI, where different riboflavin molarities had been added, to achieve a bacterial concentration of 1-4 x 10 (4)/ml. Riboflavin end molarities before illumination were 0, 100, 200, 300 and 400 microM. Each solution had a negative control. The solutions were illuminated with UVA (365 nm) for 30 minutes (5.4 J/cm(2)) and then continued for a total time of 60 minutes (10.8 J/cm(2)). A count of CFU was conducted after incubation and results compared. RESULTS: In all tested strains, a slight decrease of bacteria was seen when exposed to UV for 30 minutes. A doubling of the UV dose showed a marked decrease of bacterial count in all bacteria tested. The combination of UV and riboflavin showed a more extensive reduction of CFU, confirming an interaction effect between UV and riboflavin. CONCLUSION: Riboflavin photo-activation using UVA (365 nm) can achieve an extensive eradication of bacteria, and the combination is more potent in reducing bacterial number than UV alone.

National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-12083 (URN)10.1007/s00417-009-1231-2 (DOI)000273313100008 ()19921518 (PubMedID)
Available from: 2010-10-05 Created: 2010-10-05 Last updated: 2018-02-27Bibliographically approved
3. Response to: Bactericidal effect of photo-activated riboflavin using UVA
Open this publication in new window or tab >>Response to: Bactericidal effect of photo-activated riboflavin using UVA
2010 (English)In: Graefe's Archives for Clinical and Experimental Ophthalmology, ISSN 0721-832X, E-ISSN 1435-702X, Vol. 248, no 5, p. 757-758Article in journal (Refereed) Published
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-20755 (URN)10.1007/s00417-009-1286-0 (DOI)000276071100021 ()
Available from: 2012-01-09 Created: 2012-01-09 Last updated: 2017-12-08Bibliographically approved
4. UVA-riboflavin photochemical therapy of bacterial keratitis: a pilot study
Open this publication in new window or tab >>UVA-riboflavin photochemical therapy of bacterial keratitis: a pilot study
Show others...
2012 (English)In: Graefe's Archives for Clinical and Experimental Ophthalmology, ISSN 0721-832X, E-ISSN 1435-702X, Vol. 250, no 1, p. 95-102Article in journal (Refereed) Published
Abstract [en]

Background: The aim of this work as to investigate the photochemical interaction used in corneal crosslinking (CXL) as the primary therapy for bacterial keratitis.

Methods: A prospective non-randomized study was conducted including 16 patients with a clinical diagnosis of bacterial keratitis. No patient had any prior antibiotic treatment for the current infection. Photography and microbial culturing of the infected cornea were performed. Riboflavin was topically administered for 20 min and ultraviolet light (UVA) exposure settings for treatment of keratoconus were used. After the procedure, clinical examinations were done at least once daily until signs of improvement had been established. The frequency of examinations was thereafter reduced. Antibiotic therapy was initiated if infectious progression was suspected. The trial was registered at ISCRTN.org (no: 21432643).

Results: All eyes responded to the photochemical treatment with improvement in symptoms and signs of reduced inflammation. Epithelial healing was achieved in all cases. Antibiotic administration was necessary in two cases. One patient required a human amniotic membrane transplant.

Conclusions: This trial illustrates that photosensitization of riboflavin using UVA at 365 nm has the potential to induce healing in patients with microbial keratitis. The results from the treatment of these 16 patients with corneal ulcers indicate that UVA-riboflavin photochemical therapy merits a controlled study in order to assess its efficacy and safety compared to antibiotics.

Place, publisher, year, edition, pages
New York, USA: Springer, 2012
Keywords
UV, UVA, ultraviolet, riboflavin, CXL, keratitis, pilot study
National Category
Surgery Medical and Health Sciences
Research subject
Surgery; Medicine
Identifiers
urn:nbn:se:oru:diva-20752 (URN)10.1007/s00417-011-1754-1 (DOI)000299371000012 ()21874347 (PubMedID)2-s2.0-84857359468 (Scopus ID)
Note

Funding Agencies:

Örebro University Hospital (Sweden) OLL-57221

Futurum, the Academy of Health Care, Jonkoping (Sweden)

Available from: 2012-01-09 Created: 2012-01-09 Last updated: 2018-05-08Bibliographically approved
5. Comparison of UV-A and UV-A/Riboflavin induced growth inhibition of Acanthamoeba Castellanii
Open this publication in new window or tab >>Comparison of UV-A and UV-A/Riboflavin induced growth inhibition of Acanthamoeba Castellanii
Show others...
(English)Manuscript (preprint) (Other academic)
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-20748 (URN)
Available from: 2012-01-09 Created: 2012-01-09 Last updated: 2017-10-17Bibliographically approved

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Makdoumi, Karim

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