Swiss PACK-CXL Multicenter Trial for the Treatment of Infectious Keratitis

"Local anesthesia~\- Oxybuprocaine or Tetracaine, 1 drop each, applied together, every 3 minutes, total of 3 times~Abrasio - Abrasio: 1 mm around the borders of the infiltrate/ulcer~Corneal scrape~Hypo-osmolaric riboflavin solution~\- Apply one drop every 2 minutes for 20 minutes~UV-A irradiation~* 3 mW/cm2 for 30 minutes or 9 mW/cm2 for 10 minutes, 18 mW/cm2 for 5 minutes, 30 mW/cm2 for 3 minutes all allowed (see paper Richoz et al)~* Treatment diameter: use a irradiation diameter of 6 to 8 mm, keep the infiltrate/ulcus centered.~Additional postoperative treatment~* Homatropin or Scopolamin, if anterior chamber reaction~* Systemic NSAID/NSAR, if substantial pain~* Do not use: topical or systemic steroids, topical NSAID/NSAR, paracetamol, vitamin A ointment, patching"

"Control arm consists of standard topical antimicrobial therapy recommended for the treatment of microbial keratitis by the American Academy of Ophthalmology.~Initial empiric topical antibiotic therapy (eye drops or ocular ointment):~1a. Cefazolin (50mg/ml) in combination with either tobramycin (9-14mg/ml) or gentamicin (9-14mg/ml)."

Cycloplegic agents (cyclopentolate 1% eye drops): to decrease pain and synechia risk is at the physician discretion.

Fluoroquinolones (Besifloxacin 6 mg/ml; ciprofloxacin 3 mg/ml; gatifloxacin 3 mg/ml; levofloxacin 15 mg/ml; moxifloxacin 5 mg/ml; ofloxacin 3 mg/ml)

Corticosteroids (prednisolone acetate 0.5% or 1% eye drops): use of corticosteroids for patients included in the study only after complete closure of the epithelium