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சுருக்கம்

Topical Voriconazole Drops With and Without Intrastromal Voriconazole Injection for Treatment of Deep or Resistant Fungal Keratitis

Kamal AM Solaiman, Ayman A Alkawas, Basem M Ibrahim, Mohammad M Mahdy, Mona A Shalaby

Purpose: To compare the safety and efficacy of topical voriconazole drops with and without intrastromal voriconazole injection for treatment of deep and/or resistant fungal keratitis.

Patients and methods: A prospective, randomized and comparative study performed on eyes with deep and/or resistant fungal keratitis. Eyes were randomly allocated into two groups according to their order of presentation. Group (A) included eyes treated with intrastromal injection(s) of voriconazole (50 μg/0.1 ml) plus voriconazole eye drops 1% and group (B) included eyes treated with topical voriconazole eye drops 1% alone. Healing of the fungal keratitis was considered as the primary outcome measure. Secondary outcome measures included any reported complication as well as the visual outcome.

Results: Each group included 20 eyes with deep and/or resistant fungal keratitis. Complete healing of fungal keratitis was higher in group A (85%) than in group B (55%) and the difference was statistically significant (P<0.05). The duration of healing ranged between 2-4 weeks in group A and between 2-6 weeks in group B (P>0.05). Laboratory studies showed increased prevalence of filamentous fungi (70% in group A and 65% in group B) more than yeasts (30% in group A and 35% in group B), and the difference between both groups was statistically not significant (P>0.05).

Conclusion: Voriconazole eye drops might be effective for treatment of deep and/or resistant fungal keratitis. Adding intrastromal injection to topical drops could significantly raise the healing rate and hasten the resolution period without significant complications related to injection.