Impression Cytologic Evaluation of the Conjunctiva in Patients Treated with Topical 1% Voriconazole

Turk J Ophthalmol. 2024 Feb 22;54(1):1-4. doi: 10.4274/tjo.galenos.2023.20268. Epub 2023 Nov 27.


Objectives: The aim of the present study was to evaluate any conjunctival metaplastic changes by impression cytology in patients who underwent topical 1% voriconazole treatment for severe fungal keratitis.

Materials and methods: The study was conducted at Ege University Faculty of Medicine, Departments of Ophthalmology and Medical Pathology. Patients who were treated with 1% topical voriconazole for fungal keratitis for at least 3 months were included. The used topical voriconazole treatment was initiated as one drop every hour and was tapered according to clinical improvement in all patients. Treatment was continued 4 times a day for at least 3 months. Impression cytology samples were collected at least 3 months after cessation of topical voriconazole from the affected eyes and from the fellow eyes as a control group. Collected specimens were transferred to the pathology department for evaluation and grading (Nelson’s grading system).

Results: The mean age of the patients was 57.68±17.32 years (range, 22-87 years). The impression cytology grade of the inferior bulbar conjunctiva was 1.73±0.77 (range, 0-3) in the study group and 1.19±0.98 (range, 0-3) in the control group (p=0.03). The impression cytology grade of the temporal bulbar conjunctiva was 1.69±0.73 (range, 0-3) in the study group and 1.15±0.88 (range, 0-3) in the control group (p=0.02). The impression cytology grades of the nasal and superior bulbar conjunctiva did not differ statistically (p values 0.13 and 0.17, respectively).

Conclusion: Topical voriconazole is an effective broad-spectrum antifungal drug, but it induces conjunctival squamous metaplasia. Clinicians should be aware of this possible side effect of topical voriconazole and should carefully evaluate the conjunctiva of treated patients at each visit to detect possible metaplastic changes.

Keywords: metaplasia; voriconazole; Fungal keratitis; impression cytology.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antifungal Agents
  • Conjunctiva / pathology
  • Eye Infections, Fungal* / diagnosis
  • Eye Infections, Fungal* / drug therapy
  • Humans
  • Keratitis*
  • Middle Aged
  • Voriconazole / pharmacology
  • Young Adult


  • Voriconazole
  • Antifungal Agents