Antonopoulou NI, Spyropoulou MS, Papadakos SP, Papavasileiou GN, Dimakis AC. Bridging gaps in corneal ulcer management: Can photoactivated chromophore for infectious keratitis–corneal collagen cross-linking delay or replace therapeutic keratoplasty? World J Transplant 2026; 16(1): 109740 [DOI: 10.5500/wjt.v16.i1.109740]
Corresponding Author of This Article
Stavros P Papadakos, MD, PhD, First Department of Gastroenterology, National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", 17 Agiou Thoma Street, Goudi, Athens 11527, Greece. stavrospapadakos@gmail.com
Research Domain of This Article
Transplantation
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Mar 18, 2026; 16(1): 109740 Published online Mar 18, 2026. doi: 10.5500/wjt.v16.i1.109740
Bridging gaps in corneal ulcer management: Can photoactivated chromophore for infectious keratitis–corneal collagen cross-linking delay or replace therapeutic keratoplasty?
Niki I Antonopoulou, Maria S Spyropoulou, Stavros P Papadakos, Garyfalia N Papavasileiou, Andreas C Dimakis
Niki I Antonopoulou, Garyfalia N Papavasileiou, Andreas C Dimakis, Department of Ophthalmology, General Hospital of Athens "Laiko", Athens 11527, Attikí, Greece
Maria S Spyropoulou, First Department of Ophthalmology, General Hospital of Athens "G. Genimmatas", Athens 11527, Greece
Stavros P Papadakos, First Department of Gastroenterology, National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens 11527, Greece
Co-first authors: Niki I Antonopoulou and Maria S Spyropoulou.
Author contributions: Antonopoulou NI was responsible for the conceptualization and overall design of the manuscript; Antonopoulou NI and Spyropoulou MS wrote the first draft, performed final editing and refinement of the manuscript; Papadakos SP and Papavasileiou GN contributed to the second draft, expanding key sections on PACK-CXL efficacy and treatment stratification; Dimakis AC provided critical revision for important intellectual content; all authors have read and approved the final version of the manuscript.
Conflict-of-interest statement: The authors declare no conflicts of interest related to this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Stavros P Papadakos, MD, PhD, First Department of Gastroenterology, National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", 17 Agiou Thoma Street, Goudi, Athens 11527, Greece. stavrospapadakos@gmail.com
Received: May 20, 2025 Revised: June 7, 2025 Accepted: August 15, 2025 Published online: March 18, 2026 Processing time: 239 Days and 14.5 Hours
Abstract
The retrospective study by Edwar et al reinforces the role of therapeutic penetrating keratoplasty (PK) as a vital intervention in severe, treatment-resistant infectious keratitis. In advanced cases—often complicated by trauma, delayed presentation, and corneal perforation—PK restores globe integrity and provides limited visual recovery. However, its application is constrained by graft-related complications and donor shortages, particularly in low-resource settings. These limitations highlight the need for earlier, globe-sparing strategies to prevent progression and reduce surgical demand. Photoactivated chromophore for infectious keratitis–corneal collagen cross-linking (PACK-CXL) has emerged as a promising adjunct or alternative. With both antimicrobial and tissue-stabilizing effects, PACK-CXL may control infection and preserve corneal structure in earlier stages. A layered treatment framework that incorporates PACK-CXL as an initial intervention and reserves PK for refractory cases may help improve clinical outcomes. Further studies are needed to define their best use in practice.
Core Tip: Infectious keratitis remains a major cause of corneal blindness, particularly in low-resource settings where delayed presentation and limited access to donor tissue challenge effective management. This editorial highlights the potential of photoactivated chromophore for infectious keratitis–corneal collagen cross-linking (PACK-CXL) as an adjunct or alternative to therapeutic penetrating keratoplasty (PK). With both antimicrobial and tissue-stabilizing properties, PACK-CXL offers a globe-sparing approach that may reduce the need for PK. Integrating PACK-CXL into a stratified treatment algorithm based on ulcer severity and etiology could improve outcomes and expand access to vision-saving care.
