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Thushanthi Ramakrishnan, Marios Constantinou, Vishal Jhanji, Rasik Vajpayee; Voriconazole for Management of Fungal Keratitis. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5855.
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Infectious keratitis is a leading cause of monocular blindness worldwide and fungal pathogens account for 6-50% of these ulcers1. Fungal keratitis however remains a therapeutic challenge to ophthalmologists. Currently there is no established gold standard treatment for fungal keratitis, and the challenges in management of these patients arise due to delays in making the correct diagnosis and the limited efficacy of existing antifungal therapies. Voriconazole is a newer-generation triazole and its use both systemically and topically in the management of fungal keratitis has raised new interest with promising reports in literature suggesting that these agents may overcome the shortcomings of currently available therapies. The aim of our study was to determine the effectiveness of voriconazole in the management of fungal keratitis. 1.Lalitha P, Sharpiro B, Srinivasan M. Antimicrobial Susceptibility of Fusarium, Aspergillus, and Other Filamentous Fungi Isolated From Keratitis. Arch Ophthalmol. 2007;125:789-793
A retrospective review was undertaken of all the patients who were treated with systemic and/or topical voriconazole for management of Fungal keratitis at the Royal Victorian Eye and Ear Hospital between 2002 and 2009.
A total of 27 patients were treated with systemic and/or topical voriconazole for fungal keratitis. 13 patients responded to treatment, 11 patients required a penetrating keratoplasty and 3 patients required enucleation. Fusarium species was the most common organism isolated (N = 7), followed by Candida species (N=5). Patients who responded to treatment were younger with a mean age 50.01±15.88 (Non-responders (NR) 67.56±12.22), had better visual acuity of 0.31 ±0.31 on presentation (NR 0.07 ±0.15), and were diagnosed earlier at 10.69±9.80 days (NR 12.93±15.14). Presence of a peripheral infiltrate and hypopyon were associated with a poor outcome.
Voriconazole was effective in at least 50% of the cases in our series. It may work better in patients who are younger and present early for treatment.
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