Yalaka Jayapal Reddy, Y. Gautham Reddy, Ramapathy
INTRODUCTION: Fungal infections of the cornea usually are difficult to treat. Contemporary antifungal drugs in the treatment of mycotic keratitis are less effective than contemporary antibacterial drugs in the treatment of bacterial keratitis. Moreover, the penetration of many antifungal drugs into the cornea is suboptimal, which makes it difficult to treat cases of deep mycotic keratitis. In this present case study we report a series of thirty patients in which intrastromal voriconazole was used in conjunction with topical treatment to treat successfully deep seated recalcitrant fungal keratitis. AIM AND OBJECTIVE: To evaluate the role of intrastromal injection of voriconazole in the management of deep recalcitrant fungal keratitis as an adjunctive therapy. METHODS AND MATERIALS: In this interventional case series, thirty eyes of thirty patients with deep stromal recalcitrant fungal keratitis that were unresponsive to topical antifungal therapy underwent intrastromal injection of voriconazole 50µgms/0.1ml. Duration of study was 6 weeks per patient. RESULTS: Before the intracorneal injections, all thirty eyes had gradually worsening lesions on topical medications. After the intervention, a faster reduction in the size of corneal infiltration was documented and complete resolution of the ulcers was seen within 6 weeks of time. CONCLUSION: Targeted delivery of voriconazole by intrastromal injection may be a safe and effective way to treat cases of deep-seated recalcitrant fungal keratitis responding poorly to conventional treatment modalities.
