Intrastromal voriconazole for deep recalcitrant fungal keratitis: a case series.

Abstract

AIM:

To evaluate the outcomes of treating deep recalcitrant fungal keratitis with intrastromal voriconazole injection.

METHODS:

Twenty-five patients with culture proven fungal keratitis, not responding to a combination of topical 5% natamycin and 1% voriconazole were treated with intrastromal voriconazole (50 µg/0.1 mL) injected in five divided doses around the infiltrate to form a depot of the drug around the circumference of the lesion.

RESULTS:

The mean age of the patients was 52.52±12.21 years and mean time to presentation was 17.12±13.75 days from the onset of symptoms. The mean area of the infiltrate was 30.41±17.2 mm(2), hypopyon was present in 88% and all cases had infiltrates that extended beyond the mid-stromal level. Intrastromal voriconazole helped to resolve the infection in 18 (72%) patients and about 15% of these needed more than one injection. Smaller ulcers responded better to treatment. Fusarium spp were responsible for six of the seven cases that failed treatment.

CONCLUSIONS:

Targeted delivery of voriconazole by intrastromal injection (50 µg/0.1 mL) is a safe and effective way to treat deep recalcitrant fungal keratitis, though some may need repeated injections. Fusarium keratitis may show suboptimal response but this needs further study.

• Authors: Ganapathy Kalaiselvi, Sivananda Narayana, Tiruvengada Krishnan, Sabyasachi Sengupta
• Journal: The British journal of ophthalmology (Br J Ophthalmol) Vol. 99 Issue 2 Pg. 195-8 (Feb 2015) ISSN: 1468-2079 [Electronic] England
• PMID: 25185253 (Publication Type: Journal Article)
• Copyright: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Chemical References

• Antifungal Agents
• Voriconazole

Topics

• Adult
• Aged
• Aged, 80 and over
• Antifungal Agents (therapeutic use)
• Corneal Stroma (drug effects, microbiology)
• Corneal Ulcer (drug therapy, microbiology)
• Eye Infections, Fungal (drug therapy, microbiology)
• Female
• Follow-Up Studies
• Fungi (isolation & purification)
• Humans
• Injections, Intraocular
• Male
• Middle Aged
• Treatment Outcome
• Visual Acuity (physiology)
• Voriconazole (therapeutic use)
• Young Adult