Intrastromal voriconazole for deep recalcitrant fungal keratitis: a case series

被引:60
作者
Kalaiselvi, Ganapathy [1 ]
Narayana, Sivananda [1 ]
Krishnan, Tiruvengada [1 ]
Sengupta, Sabyasachi [1 ]
机构
[1] Aravind Eye Hosp, Cornea & Refract Serv, Pondicherry 605007, India
关键词
INTRACAMERAL AMPHOTERICIN-B; TOPICAL VORICONAZOLE; INJECTION; KERATOMYCOSIS; NATAMYCIN; FLUCONAZOLE; CASPOFUNGIN; MANAGEMENT; ULCER;
D O I
10.1136/bjophthalmol-2014-305412
中图分类号
R77 [眼科学];
学科分类号
100212 ;
摘要
Aim To evaluate the outcomes of treating deep recalcitrant fungal keratitis with intrastromal voriconazole injection. Methods Twenty-five patients with culture proven fungal keratitis, not responding to a combination of topical 5% natamycin and 1% voriconazole were treated with intrastromal voriconazole (50 mu g/0.1 mL) injected in five divided doses around the infiltrate to form a depot of the drug around the circumference of the lesion. Results The mean age of the patients was 52.52 +/- 12.21 years and mean time to presentation was 17.12 +/- 13.75 days from the onset of symptoms. 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 18 (72%) patients and about 15% of these needed more than one injection. Smaller ulcers responded better to treatment. Fusarium spp were responsible for six of the seven cases that failed treatment. Conclusions Targeted delivery of voriconazole by intrastromal injection (50 mg/0.1 mL) is a safe and effective way to treat deep recalcitrant fungal keratitis, though some may need repeated injections. Fusarium keratitis may show suboptimal response but this needs further study.
引用
收藏
页码:195 / 198
页数:4
相关论文
共 25 条
  • [1] Al-Badriyeh D, 2010, CLIN OPHTHALMOL, V4, P391
  • [2] Antifungal susceptibility profile of clinical Fusarium spp. isolates identified by molecular methods
    Alastruey-Izquierdo, Ana
    Cuenca-Estrella, Manuel
    Monzon, Araceli
    Mellado, Emilia
    Luis Rodriguez-Tudela, Juan
    [J]. JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, 2008, 61 (04) : 805 - 809
  • [3] Activities of caspofungin, itraconazole, posaconazole, ravuconazole, voriconazole, and amphotericin B against 448 recent clinical isolates of filamentous fungi
    Diekema, DJ
    Messer, SA
    Hollis, RJ
    Jones, RN
    Pfaller, MA
    [J]. JOURNAL OF CLINICAL MICROBIOLOGY, 2003, 41 (08) : 3623 - 3626
  • [4] Intracorneal injection of amphothericin B for recurrent fungal keratitis and endophthalmitis
    Garcia-Valenzuela, E
    Song, CD
    [J]. ARCHIVES OF OPHTHALMOLOGY, 2005, 123 (12) : 1721 - 1723
  • [5] Voriconazole in the treatment of fungal eye infections: a review of current literature
    Hariprasad, S. M.
    Mieler, W. F.
    Lin, T. K.
    Sponsel, W. E.
    Graybill, J. R.
    [J]. BRITISH JOURNAL OF OPHTHALMOLOGY, 2008, 92 (07) : 871 - 878
  • [6] Isipradit Saichin, 2008, Journal of the Medical Association of Thailand, V91, P309
  • [7] Recalcitrant fungal tunnel infection treated with intrastromal injection of voriconazole
    Jain V.
    Borse N.
    Shome D.
    Natarajan S.
    [J]. International Ophthalmology, 2010, 30 (6) : 723 - 725
  • [8] Development of Effective Ocular Preparations of Antifungal Agents
    Kaur, Indu Pal
    Rana, Cheena
    Singh, Harinder
    [J]. JOURNAL OF OCULAR PHARMACOLOGY AND THERAPEUTICS, 2008, 24 (05) : 481 - 493
  • [9] Intracameral amphotericin B - Initial experience in severe keratomycosis
    Kaushik, S
    Ram, J
    Brar, GS
    Jain, AK
    Chakraborti, A
    Gupta, A
    [J]. CORNEA, 2001, 20 (07) : 715 - 719
  • [10] Intracameral voriconazole: In vitro safety for human ocular cells
    Kernt, M.
    Kamplik, A.
    [J]. TOXICOLOGY, 2009, 258 (2-3) : 84 - 93