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Olivier Richoz, Florence Hoogewoud, David Tabibian, Arthur Hammer, Farhad Hafezi; Optimizing fluence settings and riboflavin composition for collagen cross-linking (CXL) in the antimicrobial efficiency against Pseudomonas aeruginosa and Staphylococcus aureus.. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5791.
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When treating bacterial keratitis, determination of the correct pathogen is often clinically challenging. The benefits of using CXL to treat corneal infections is that the treatment is not pathogen-specific. In an attempt to optimize the treatment parameters, we analyzed the effect of high fluence CXL on the bacterial killing rate in an in vitro model using Pseudomonas aeruginosa.
The killing rate of a known concentration of bacterias (Pseudomonas aeruginosa and Staphylococcus aureus) was analyzed for the following conditions: 1) preservative-free riboflavin, with UV-A irradiation @ 18 mW/cm2 for 5 minutes 2) preservative-free riboflavin, with UV-A irradiation @ 36 mW/cm2 for 2.5 minutes 3) riboflavin with preservatives, with UV-A irradiation @ 18 mW/cm2 for 5 minutes 4) riboflavin with preservatives, with UV-A irradiation @ 36 mW/cm2 for 2.5 minutes 5) riboflavin only, no UVA 6) riboflavin with preservatives, no UVA. We used 0.1% riboflavin in all experiments.
The groups with preservative-free riboflavin showed a killing rate of 2 logs with 18 mW/cm2 and one log with 36 mW/cm2. The groups with riboflavine with preservatives showed a killing rate of 2 logs (98 %) with both fluences.
The P. aeruginosa and S. aureus killing rate is fluence-dependent when using conventional riboflavin and fluence-independent when preservatives are added to the riboflavin solution. These findings will allow the generation of optimized riboflavin solutions for the treatment of bacterial keratitis.
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