Bindu Madhavi R.1, Manjula Y.M.2, Suma C.3, Soumya Basanth4, Nibedita Acharya5
BACKGROUND
Treatment of fungal ulcers is one of the most challenging tasks. Various topical
antifungal drugs have poor corneal stromal penetration. Voriconazole is a broad
spectrum drug and is an effective agent for the treatment of fungal keratitis as a
topical preparation. It is potent against a broad range of clinically significant fungal
infections both in the eye as well systemically. In tropical climatic conditions
filamentous fungi commonly cause eye infections and are associated with poor
visual outcomes. The treatment options for mycotic ulcers are limited, therefore
direct intrastromal injections are helpful in the management of these deep mycotic
keratitis. We wanted to evaluate the role of intrastromal injection of voriconazole
in the management of deep fungal keratitis not responding to conventional
therapy.
METHODS
This an interventional case series study done at a tertiary care centre in south
India from the year April 2019 to August 2020. Eight eyes of eight patients with
microbiologically proven deep stromal recalcitrant mycotic keratitis not responding
to topical antifungal medications were evaluated. Voriconazole 50 microgram / 0.1
ml was injected around the infiltrate in the corneal stroma as an adjunctive to the
topical antifungal treatment. Main outcome measure was a reduction of the size
of the infiltrate and ulcer and decrease in infection on regular follow ups.
RESULTS
Before injecting voriconazole, all the cases were of either gradually worsening of
lesions on topical treatment, or not responding to topical treatment. After the
injection a rapid decrease in the size of corneal ulcer, hypopyon, and infiltration
was seen within 3 weeks.
CONCLUSIONS
Targeted delivery of intrastromal voriconazole may be a safe and effective way in
the management of deep seated fungal ulcers which respond poorly to
conventional treatment procedures, thus reducing the need for further surgical
treatment.
