Intrastromal and intracameral voriconazole combination: An adjuvant therapy in intractable mycotic keratitis

Abstract

: To study role of intrastromal and intracameral voriconazole combination in recalcitrant fungal Keratitis.: 20 cases of recalcitrant fungal keratitis involving >50% stromal thickness and not showing good response to oral fluconazole, topical natamycin (5%) and topical voriconazole (1%) eye drops after 4 weeks of treatment were included in the study after taking informed written consent. Patients with impending or frank perforation, scleral involvement and endophthalmitis were excluded from the study. 30 min before the procedure, patient was given Tab acetazolamide 250mg stat to lower the intraocular pressure (IOP). Then under all aseptic conditions, 50 microgram/0.1 ml dose of intrastromal and intracameral voriconazole was given with 30G needle. Cases were examined daily for 1 week and then every week for 4 weeks for monitoring progression of fungal keratitis. Out of 20 cases, 18 (90%) patients showed significant improvement after 4 weeks. Depending on the response after 1 week, patients were planned for repeat injection and only 1 patient required >3 injections in whom Lasiodiplodia theobromae was the causative organism. Only 1 patient got worsened and was ultimately managed with therapeutic keratoplasty. Intrastromal and intracameral voriconazole combination is an easy procedure with short learning curve which is highly efficacious and cost effective in recalcitrant fungal keratitis.