Yasin A. Khan

Riboflavin and ultraviolet light a therapy as an adjuvant treatment for medically refractive Acanthamoeba keratitis: report of 3 cases.

PURPOSE To present the first 3 cases of Acanthamoeba keratitis (AK), unresponsive to medical treatment, that were successfully treated with a novel adjunctive therapy using ultraviolet light A (UVA) and riboflavin (B2). DESIGN Interventional case series. PARTICIPANTS Two patients with confirmed AK and 1 patient with presumptive AK, which were all refractive to multidrug conventional therapy. INTERVENTION Two treatment sessions involving topical application of 0.1% B2 solution to the ocular surface combined with 30 minutes of UVA irradiation focused on the corneal ulcer. MAIN OUTCOME MEASURES Clinical examination by slit lamp, confocal microscopy, and histopathology, when available. RESULTS All patients in these series showed a rapid reduction in their symptoms and decreased ulcer size after the first treatment session. The progress of the clinical improvement began to slow after 1 to 3 weeks of the first application and was then renewed after the second application. All ancillary signs of inflammation mostly resolved after the second treatment session. The ulcers in all patients continued to decrease and were closed within 3 to 7 weeks of the first application. Two patients developed dense central corneal scars, and penetrating keratoplasty was performed for visual rehabilitation. Histopathologic examination of the excised tissue revealed no Acanthamoeba organisms. The remaining patient had no symptoms or signs of infection, both clinically and by confocal microscopy, and was left with a semitransparent eccentric scar that did not affect visual acuity. CONCLUSIONS The adjunctive use of UVA and B2 therapy seems to be a possible alternative for selected cases of medication-resistant AK.

Assessing Efficacy of Combined Riboflavin and UV-A Light (365 nm) Treatment of Acanthamoeba Trophozoites

PURPOSE To assess the Acanthamoeba trophozoite viability in vitro and treatment of Acanthamoeba keratitis in a hamster model using ultraviolet light A (UV-A) and riboflavin (B2). METHODS A sample of Acanthamoeba sp. cultured was transferred to a 96-well plate and exposed to B2 and the UV-A light (365 nm wavelength) at a power density of 3 mW/cm(2), 8 mm spot diameter, for 30 minutes. The exposure was done in triplicate. Control groups were prepared in triplicate as well: blank control, UV-A only, riboflavin only, and dead control. Cell viability assessment was done using the trypan blue dye exclusion method. Acanthamoeba keratitis was induced in Chinese hamsters; who were randomly assigned to one of the animal groups: UV-A + B2, propamidine isethionate (Brolene; Sanofi-Aventis, Ellerslie, Auckland, Australia), UV-A + B2 + propamidine isethionate (Brolene), only UV-A, only B2, and blank. Throughout the 14 days after treatment the animals were examined clinically. Histology and clinical scores of all groups were compared. RESULTS The in vitro study showed no difference between the treatment group UV-A + B2 and the control groups. In the hamster keratitis model a significant improvement of clinical score was observed for the groups propamidine isethionate (Brolene) and UV-A + B2 + propamidine isethionate (Brolene) (P = 0.0067). Also a significant worsening of clinical score was observed in the other groups: UV-A + B2 group (P = 0.0084), only UV-A (P = 0.0078), B2 only (P = 0.0084), and blank (P = 0.0082). No difference was observed between propamidine isethionate (Brolene) and UV-A + B2 + propamidine isethionate (Brolene). CONCLUSIONS The adjunctive use of UV-A and B2 therapy did not demonstrate antitrophozoite activity; in vivo UV-A and B2 did not demonstrate efficacy in this model.

Efficacy of three different methods for side port incision wound sealing

PURPOSE: To evaluate wound leakage and bacteria-sized particle influx in differently corneal sealed side port incisions. METHODS: Four 1.5mm tunnel squared incisions were created in each of four cadaveric human eyes. In each cornea, one incision was left unsealed, whereas the other three incisions were sealed using a 10-0 nylon suture, cyanoacrylate glue, or stromal hydration, respectively. A Seidel and an India ink test were performed on each eye. During each Seidel test, flourescein was applied, the IOP increased from 15 to 80mmHg, and the IOP at which each incision started to leak recorded. During each India ink test, ink was placed on the eye and rinsed out with balanced salt solution (BSS). Ink penetration was then measured by planimetry at physiologic conditions and after an IOP plunge from 80mmHg to 0mmHg. RESULTS: Regardless of IOP variations, no leakage or ink inflow was observed through the glued incisions. In contrast, leakage did occur in the other three sealing methods, albeit at significantly different IOP levels in each one (p=0.013). Ink inflow occurred in these sealing methods at physiologic IOP and, to a significantly greater extent, after the IOP challenge (p<0.05). At both of these IOP conditions, the differences in ink influx among these three incision-sealing methods were deemed statistically insignificant. CONCLUSION: This study showed that glue was more effective at preventing wound leakage and bacteria-sized particle influx than other commonly used methods especially hydrosealing.