Purpose: To evaluate the role of intrastromal injection of voriconazole in the management of deep recalcitrant fungal keratitis.
Design: Interventional case series.
Setting: Cornea services at a tertiary care teaching hospital.
Patients: Three eyes of three patients with deep stromal recalcitrant fungal keratitis not responding to topical antifungal medications. Intervention Procedure: Voriconazole 50 micrograms/0.1 ml was injected circumferentially around the fungal abscess in the corneal stroma as an adjunctive to the topical antifungal therapy.
Main outcome measure: Main outcome measure was a reduction in size of the abscess and resolution of the infection.
Results: Before the intracorneal injection, all three eyes had gradually worsening lesions on topical medications. After the intervention, a faster reduction in the size of corneal infiltration was documented and a complete resolution of the ulcers was seen within three weeks in all cases.
Conclusion: Targeted delivery of voriconazole by intracorneal injection may be a safe and effective way to treat cases of deep-seated recalcitrant fungal keratitis responding poorly to conventional treatment modalities.