Evaluation of intrastromal injection of voriconazole as a therapeutic adjunctive for the management of deep recalcitrant fungal keratitis.

PURPOSE

To evaluate the role of intrastromal injection of voriconazole in the management of deep recalcitrant fungal keratitis.

DESIGN

Interventional case series.

SETTING

Cornea services at a tertiary care teaching hospital.

PATIENTS

Three eyes of three patients with deep stromal recalcitrant fungal keratitis not responding to topical antifungal medications. Intervention Procedure: Voriconazole 50 micrograms/0.1 ml was injected circumferentially around the fungal abscess in the corneal stroma as an adjunctive to the topical antifungal therapy.

MAIN OUTCOME MEASURE

Main outcome measure was a reduction in size of the abscess and resolution of the infection.

RESULTS

Before the intracorneal injection, all three eyes had gradually worsening lesions on topical medications. After the intervention, a faster reduction in the size of corneal infiltration was documented and a complete resolution of the ulcers was seen within three weeks in all cases.

CONCLUSION

Targeted delivery of voriconazole by intracorneal injection may be a safe and effective way to treat cases of deep-seated recalcitrant fungal keratitis responding poorly to conventional treatment modalities.