Abstract
Introduction
Photoactivated Chromophore for Keratitis-Corneal Cross-linking (PACK-CXL) as a topic of research is gaining momentum. We sought to characterize the related scholarly literature utilizing a big-data text-mining approach, identifying gaps in clinical reporting, outcome focus, and therapeutic positioning.
Methods
A highly sensitive search was performed using the Lens.org scholarly aggregator (encompassing PubMed, Crossref, and OpenAlex). To isolate modern clinical applications, records underwent automated temporal restriction (post-2000) and ophthalmic scope filtering to exclude industrial photochemical noise. Bibliometric visualization was conducted using Python-based natural language processing and VOSviewer. Clinical variables were tagged using a non-deterministic, multi-label text-mining framework to eliminate subjective classification bias.
Results
The search identified 10,352 records; after deduplication and screening, 1,429 records (13.8%) were included in the final analysis. Evaluation of explicit clinical positioning revealed a distinct paradigm shift: comparative framing (n=332; 23.2%) overwhelmingly dominated the literature, far exceeding adjunctive (n=77; 5.4%) or rescue/refractory applications (n=47; 3.3%). Regarding pathogen targets, bacterial keratitis was the most frequently represented etiology (n=352; 24.6%), followed by fungal (n=290; 20.3%) and Acanthamoeba (n=120; 8.4%). Riboflavin/UVA remained the primary explicitly discussed modality (11.1%) compared to Rose Bengal/Green light (3.1%). Abstract-level reporting of clinical outcomes remained structurally focused, with mentions of healing/epithelialization (40.4%) consistently outpacing explicit functional mentions of visual acuity (20.4%).
CONCLUSION:s The PACK-CXL literature demonstrates exponential growth with a definitive shift toward comparative study framing, possibly signaling a transition from a 'salvage' therapy to standard-of-care evaluation. Regardless, abstract-level reporting remains inconsistent and weighted toward structural endpoints; future work would benefit from standardized reporting of visual acuity, epithelial healing, microbiologic cure, and keratoplasty outcomes.