The Effects of Intrastromal Voriconazole Injection and Topical Voriconazole in the Treatment of Recalcitrant Fusarium Keratitis

Abstract

To describe the course and outcome in 3 patients with recalcitrant fungal keratitis treated with intrastromal voriconazole injection and topical voriconazole application. The present study was an interventional case series. A 50 μg/0.1 mL solution of voriconazole was injected into the corneal stromal tissue around the corneal ulcer, and 1% topical voriconazole was added to the therapeutic regimen if the ulcer failed to respond to 5% topical natamycin hourly and oral ketoconazole twice per day. The infiltration and epithelial defect size were measured at each visit using a slit-lamp biomicroscope. Anatomical outcomes were assessed. A dramatic therapeutic response was observed in 2 patients. An amniotic membrane transplantation using cyanoacrylate glue was required to seal the microperforation in a patient with a chemical burn superinfected with Fusarium. Intrastromal injection of voriconazole together with topical voriconazole effectively reduced the infiltration size and controlled the infection in patients with Fusarium keratitis. However, continued application of the topical medication is critical for a favorable outcome of treatment.