Impaction of interventional study with intrastromal voriconazole in recalcitrant deep fungal keratitis

Abstract

Aim: To evaluate the efficacy and outcome of intrastromal voriconazole, as treatment for management of recalcitrant fungal keratitis. Methods: Thirty patients with fungal keratitis, not responding to a topical antifungal medications, were treated with intrastromal voriconazole (50 μg/0.1 mL) injected around the circumference of the lesion. Results: The mean area of the infiltrate was 30.41±17.2 mm(2), hypopyon was present in 88% and all cases had infiltrates that extended beyond the mid-stromal level. Intrastromal voriconazole helped to resolve the infection in 30 patients. The improvement of BCVA in twenty seven patients from PL+,PR+ to CF-1mt group to 6/18 to 6/19 group another one patients from same group to CF-2mts to CF- 4mts and two patient to 6/60 to 6/24 group. This shows great significance of intrastromal voriconazole injection. In some patients there was a minimal improvement in BCVA atributtable to involvment of the abscesses and the resultant scar in the central cornea. Conclusions: Management of recalcitrant fungal keratitis with voriconazole by intrastromal injection (50 μg/0.1 mL) is a safe and effective way to treat deep recalcitrant fungal keratitis, though some may need repeated injections.