Evaluation of intrastromal injection of voriconazole as a therapeutic adjunctive for the management of deep recalcitrant fungal keratitis

Am J Ophthalmol. 2008 Jul;146(1):56-59. doi: 10.1016/j.ajo.2008.02.023. Epub 2008 Apr 24.

Abstract

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.

MeSH terms

  • Adult
  • Antifungal Agents / administration & dosage*
  • Aspergillosis / drug therapy*
  • Aspergillosis / microbiology
  • Aspergillus / isolation & purification
  • Corneal Stroma / drug effects*
  • Corneal Stroma / microbiology
  • Corneal Ulcer / drug therapy*
  • Corneal Ulcer / microbiology
  • Eye Infections, Fungal / drug therapy*
  • Eye Infections, Fungal / microbiology
  • Fusarium / isolation & purification*
  • Humans
  • Injections, Intralesional
  • Male
  • Middle Aged
  • Pyrimidines / administration & dosage*
  • Treatment Outcome
  • Triazoles / administration & dosage*
  • Voriconazole

Substances

  • Antifungal Agents
  • Pyrimidines
  • Triazoles
  • Voriconazole