Amphotericin B versus Voriconazole in the treatment of fungal keratitis: a comparative study

Purpose Evaluate the efficiency and safety of Voriconazole compared with Amphotericin B in the treatment of fungal keratitis. Background Fungal keratitis in Egypt is considered the second prevalent corneal infection after bacterial keratitis. It is one of the main causes of corneal blindness in Egypt. Many recalcitrant cases are frequently met with. Delay in the diagnosis and management usually leads to complications. Patients and methods During the period from July 2016 to October 2019, 106 patients who were clinically diagnosed in one eye as fungal keratitis, followed by culture and histopathological proof were recruited. They were divided into groups A and B. One hundred and six eyes of 106 patients whose age ranged from 10 to 74 years of both sexes were recruited, 53 eyes in each group. Group A received Amphotericin B while group B received Voriconazole. Adjuvant measures were used in deteriorating progressive cases in the form of cyanoacrylate glue with a high oxygen permeability contact lens in impending perforation, intrastromal Voriconazole injection, and lastly therapeutic penetrating keratoplasty. Follow-up was done on days 1, 3, 7, then weekly until cure. Size, depth, deep vascularization, presence of satellites, intraocular pressure monitoring, hypopyon, and any complication were recorded. Visual acuity and healing outcome and duration to achieve were also recorded. Results In all, 80 cases (39 of group A and 41 of group B) were healed, 21 cases (11 of group A and 10 of group B) progressed and needed adjuvant treatment to heal, five cases (three of group A and two of group B) needed urgent therapeutic penetrating keratoplasty. Voriconazole group showed a shorter time for healing and less complications. Discussion Voriconazole was slightly better than Amphotericin B as regards the duration for healing, progression of keratitis, extent of deep vascularization, density of the healed scar, and visual acuity. Conclusion Both Amphotericin B and Voriconazole were successful in treating fungal keratitis. Voriconazole showed statistically significant better results.