Amniotic membrane transplantation with intra-stromal Voriconazole versus amniotic membrane transplantation with argon laser photocoagulation for treatment of resistant fungal keratitis

Abstract

Background Fungal keratitis is a serious problem that may affect vision. Many procedures like argon laser, voriconazole injection, and amniotic membrane transplantation (AMT) may be used to control infection. Aim To compare between intrastromal voriconazole injection with AMT and argon laser photocoagulation with AMT as treatment for fungal keratitis. Patients and methods Mycotic keratitis cases were divided in two groups, with 15 cases each. In one group, intrastromal voriconazole injection and AMT in the same setting was done, and in the other group, argon laser photocoagulation and AMT in the same setting was done. The studied cases included 21 cases with mixed infection and nine cases were pure fungal keratitis according to culture results. In the voriconazole group, intrastromal injection followed by AMT was done, whereas in the argon group, the corneal ulcer was irradiated with argon after fluorescein staining followed by AMT in the same settings. Results Healing was achieved in both groups in 2–6 weeks in all cases. Less than 50% of cases of the voriconazole group healed by the third week, whereas 80% of cases of the argon laser group healed by the third week. Vision was increased in four (26.7%) patients in the voriconazole group, whereas in six (40%) cases in the argon laser group. Conclusions Argon laser with AMT gives better results than intrastromal voriconazole injection with AMT for the treatment of resistant mycotic keratitis.