Intrastromal voriconazole: the next effective adjunctive treatment for recalcitrant keratomycosis.

International Journal of Biomedical Research

Ravi Kant Bamotra²  Meenakshi Sindhu³  Shazia Qayum⁴ 

[1] Hospital, Chandigarh;Hospital, Chandigarh-160030;Department of Ophthalmology, Government Medical College &Government Medical College &Maharishi Markandeshwar University, Mullana, Ambala, Haryana-133207

关键词: Keratomycosis;    Recalcitrant ulcer;    Anti-fungals;    Intra-stromal injection;    Voriconazole;   

DOI  :  10.7439/ijbr.v7i5.3218

学科分类：基础医学

来源: Scholar Science Journals

【 摘 要 】

Introduction: Fungal keratitis is a commonly encountered infection of the cornea which may lead to moderate to severe visual loss.Aim: To report the result of intra-stromal voriconazole in refractory keratomycosis.Method: Fungal keratitis is a commonly encountered infection of the cornea which may lead to moderate to severe visual loss. It may be caused by several species of fungi and accounts for nearly 50% of all cases of infectious keratitis in developing countries. The penetration of antifungal drugs into the deeper layers of cornea is sub-optimal, thus making it difficult to treat cases of deep fungal keratitis. We report two cases of refractory fungal keratitis; one caused by aspergillus fumigates and other by fusarium as seen on lactophenol cotton blue mount from scrapings. Both the cases were resistant to topical 5% natamycin and 1 % voriconazole and therefore, intra-stromal voriconazole reconstituted to 50 microns / 0.1 ml was injected circumferentially into the mid-stroma in close proximity to the ulcer margins in both the cases.Result: A marked reduction in the size of ulcer (both epithelial defect and infiltrates) was noted at 72 hours after intra-stromal voriconazole. A repeat injection was given in both the cases four days after the first injection. No complications were seen in any of the cases.Conclusion: Intra-stromal voriconazole offers an effective adjunctive in treating refractory keratomycosis as the direct deposition of drug into deeper stroma results into higher therapeutic concentrations into ulcer; thus obviating the need for therapeutic penetrating keratoplasty in such patients.

【 授权许可】

CC BY