Effects of Lamellar Keratectomy and Intrastromal Injection of 0.2% Fluconazole on Fungal Keratitis

Purpose. To evaluate efficacy and safety of novel tricyclic corneal stroma injection (TCSI) voriconazole for the treatment of fungal keratitis. Methods. This retrospective cohort study included data of 57 patients (57 eyes) with fungal keratitis. The TCSI group consisted of 27 patients (27 eyes) who were injected voriconazole once via TCSI procedure within one week after enrollment, in addition to conventional antifungal treatment. The control group consisted of 30 patients (30 eyes) who were treated using conventional antifungal treatment modalities. The outcome measures consist of the 3-week and 3-month best-corrected visual acuity (BCVA) values and size of infiltrate or scar, time to re-epithelialization, corneal perforation rate and/or therapeutic penetrating keratoplasty (TPK) requirement, the preoperative and post-TCSI corneal endothelial cell density (ECD), and the intraocular pressure (IOP) of the treated eye and the respective contralateral eye. Results. There were no significant differences in the baseline demographic and clinical characteristics between the two groups. 3 weeks and 3 months after enrollment, the TCSI group exhibited an increase in visual acuity ( P < 0.05 ), and there was no significant difference in the size of infiltrate or scar between two groups ( P > 0.05 ). Time to re-epithelialization was shorter in the TCSI group than in the control group ( P < 0.05 ). There was no statistically significant difference between corneal ECD on the day before and 7 days after TCSI and the IOP of treated and contralateral healthy eyes on the day before and 1 day, 3 days, 7 days, and 1 month after TCSI ( P > 0.05 ). The difference in the risk of perforation and/or TPK requirement was not statistically significant between two groups ( P > 0.05 ). Conclusion. Localized injection of voriconazole using TCSI may be a minimally invasive, safe, and effective adjuvant treatment modality for fungal keratitis.

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Non-traditional Route for Three Antifungal Drugs in Fungal Keratitis Treatment

Ophthalmology Research An International Journal ◽

10.9734/or/2019/v10i230104 ◽

2019 ◽

pp. 1-11

Author(s):

Christine R Sedhom ◽

Mohamed S Abdel-Rahman ◽

Mohamed S Hussein

Keyword(s):

Clinical Study ◽

Study Design ◽

Fungal Keratitis ◽

Antifungal Drugs ◽

University Hospital ◽

Complete Cure ◽

Intrastromal Injection

Aims: This study aims to evaluate the efficacy of the intrastromal route of antifungal drugs in treatment of fungal keratitis. Study Design: Prospective non-controlled (single arm) interventional clinical study Place and Duration of Study: Ophthalmology Department, Assiut University Hospital, between March 2016 to November 2017. Methodology: Corneal scrapings for direct smears and cultures were done for eighteen eyes of 18 consecutive patients and intrastromal injections were given according to sensitivity results. Results: After one month of follow up of the cases in this study, 33.3% of the cases had rapid complete cure and the rest had incomplete cure with resolution of ulcer sizes by 55.34% ±6.78 after one or more intrastromal injection of antifungal drugs. Conclusion: Intrastromal injection of antifungal drugs in treatment of fungal keratitis shows promising results in advanced cases of fungal keratitis when combined with the topical route.

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Intrastromal Injection of Voriconazole in the Treatment of Deep Fungal Keratitis - A Prospective Study in a Tertiary Care Centre in South India

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/285 ◽

2021 ◽

Vol 8 (20) ◽

pp. 1505-1509

Author(s):

Bindu Madhavi R ◽

Manjula Y.M ◽

Suma C ◽

Soumya Basanth ◽

Nibedita Acharya

Keyword(s):

Topical Treatment ◽

South India ◽

Tertiary Care ◽

Fungal Keratitis ◽

Antifungal Drugs ◽

Care Centre ◽

Mycotic Keratitis ◽

Tertiary Care Centre ◽

Case Series Study ◽

Intrastromal Injection

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. KEYWORDS Intrastromal Injection, Voriconazole, Fungal Keratitis, Deep Mycotic Keratitis

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Evaluation of Intrastromal Injection of Voriconazole as a Therapeutic Adjunctive for the Management of Deep Recalcitrant Fungal Keratitis

American Journal of Ophthalmology ◽

10.1016/j.ajo.2008.02.023 ◽

2008 ◽

Vol 146 (1) ◽

pp. 56-59.e2 ◽

Cited By ~ 67

Author(s):

Gaurav Prakash ◽

Namrata Sharma ◽

Manik Goel ◽

Jeewan S. Titiyal ◽

Rasik B. Vajpayee

Keyword(s):

Fungal Keratitis ◽

Intrastromal Injection

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Effects of Lamellar Keratectomy and Intrastromal Injection of 0.2% Fluconazole on Fungal Keratitis

Journal of Ophthalmology ◽

10.1155/2015/656027 ◽

2015 ◽

Vol 2015 ◽

pp. 1-10 ◽

Cited By ~ 1

Author(s):

Xinying You ◽

Jun Li ◽

Suxia Li ◽

Weiyun Shi

Keyword(s):

Wound Healing ◽

Visual Acuity ◽

Corneal Thickness ◽

Fungal Keratitis ◽

Maximum Depth ◽

Corrected Visual Acuity ◽

Uncorrected Visual Acuity ◽

Antifungal Chemotherapy ◽

Intrastromal Injection ◽

Best Corrected Visual Acuity

Purpose. To evaluate effects of lamellar keratectomy and intrastromal injection of 0.2% fluconazole (LKIIF) on fungal keratitis.Methods. Data for 54 eyes of consecutive patients with fungal keratitis treated with LKIIF were retrospectively analyzed. The lesions in these eyes did not heal or were aggravated after antifungal chemotherapy for 7 days. The maximum lesion diameters were ≤5 mm and maximum depth was not more than half of full corneal thickness. Cases were followed up for at least 90 days.Results. Forty-six eyes were cured (85.2%). The wound healing times were 3–16 days and were less than 7 days in 28 cases (51.9%). In cured eyes, uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA) were both 20/250–20/20. The UCVA improved in 38 eyes and was unchanged in seven eyes. BCVA improved in 44 eyes and was unchanged in two eyes. When followed up for more than 90 days, 89% (41 of 46 eyes) showed improvement in UCVA and 11% were unchanged. Regarding BCVA, 98% improved and one eye was unchanged. No other complications were observed except neovascularization in one eye and thinner corneas.Conclusions. LKIIF was quick and effective for small fungal keratitis confined to half of the corneal thickness.

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