Treatment Outcomes of Intrastromal Voriconazole Injection for Fungal Keratitis
Keywords:
corneal ulcer, intracorneal injection, mycotic keratitisAbstract
Objectives: To study the treatment outcomes of intrastromal voriconazole injections in patients with resistant mycotic keratitis in terms of clinical characteristics and associated risk factors for treatment success.
Methods: We retrospectively reviewed 70 medical records at a tertiary referral center in Northeastern Thailand from November 2015 to January 2020. The patients had fungal keratitis resistant to topical antifungal eye drops, with or without systemic antifungal therapy, and underwent intrastromal voriconazole injection. The recorded data included demographic information, possible risk factors, microbiological studies, clinical findings, procedures, clinical outcomes, and complications of the injections.
Results: Of the 70 patients, 15.2% showed improvement, while the others required therapeutic penetrating keratoplasty (TPK) or evisceration. The mean size of the ulcer was 4.84 mm. Ulcer < 4 mm and the presence of hypopyon were associated with treatment failure (p=0.015 and p=0.003, respectively). Vegetative materials were the most common risk factor. Fusarium species were isolated from 57.1% of the identified organisms. The most common complications were new corneal infiltrations and hyphemas.
Conclusions: Intrastromal voriconazole injection reduces the need for therapeutic penetrating keratoplasty or evisceration, as approximately one-sixth of patients with non-healing fungal keratitis responded to it.
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