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- W4253607372 abstract "We appreciate this opportunity to respond to concerns regarding our clinical trial.1Prajna N.V. Radhakrishnan N. Lalitha P. et al.Cross-linking-assisted infection reduction: a randomized clinical trial evaluating the effect of adjuvant cross-linking on outcomes in fungal keratitis.Ophthalmology. 2020; 127: 159-166Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar This trial studied the Dresden protocol, approved by the US Food and Drug Administration, with 1 small modification; we debrided the cornea over the area of infiltrate only. Given that baseline median infiltrate size is outlined in Table 1 (in the original article), the approximate fluence delivered to the average ulcer can be estimated. We certainly agree that this protocol may be optimized in the future and that it is a worthy area of future study. We note that the important work Hafezi et al have done in this area has focused around bacterial and not fungal keratitis. We would point out that photochemically activated riboflavin has much more antibacterial than antifungal effect in vitro; therefore, small adjustments to the protocol are likely to make more of a difference in bacterial keratitis.2Martins S.A. Combs J.C. Noguera G. et al.Antimicrobial efficacy of riboflavin/UVA combination (365 nm) in vitro for bacterial and fungal isolates: a potential new treatment for infectious keratitis.Invest Ophthalmol Vis Sci. 2008; 49: 3402-3408Crossref PubMed Scopus (191) Google Scholar,3Sauer A. Letscher-Bru V. Speeg-Schatz C. et al.In vitro efficacy of antifungal treatment using riboflavin/UV-A (365 nm) combination and amphotericin B.Invest Ophthalmol Vis Sci. 2010; 51: 3950-3953Crossref PubMed Scopus (70) Google Scholar Finally, our study suggested visual acuity outcomes and scar sizes were worse among study participants randomized to corneal crosslinking, which may limit the application of this therapy regardless of its antimicrobial effects. It is difficult to know whether an intervention is effective until it is tested in a randomized clinical trial; therefore, we look forward to seeing the results of the Swiss PACK-CXL trial as well as our own National Institutes of Health-funded bacterial keratitis trial, Steroids and Cross-linking for Ulcer Treatment. Re: Prajna et al.: Cross-Linking—Assisted Infection Reduction: a randomized clinical trial evaluating the effect of adjuvant cross-linking on outcomes in fungal keratitis (Ophthalmology. 2020;127:159–166)OphthalmologyVol. 128Issue 1PreviewPrajna et al1 published a randomized controlled clinical trial of corneal crosslinking (CXL) for the treatment of filamental fungal keratitis. They concluded, “there appears to be no benefit of adjuvant CXL in the primary treatment of moderate filamentous fungal ulcers, and it may result in decreased visual acuity.” Full-Text PDF" @default.
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