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N. Sharma, P. C. Agarwal, R. Sinha, J. S. Titiyal, R. B. Vajpayee; Evaluation of Intrastromal Voriconazole Injection as an Adjunct in the Management of Deep Recalcitrant Fungal Keratitis. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5118.
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To evaluate the role of intrastromal voriconazole injection in the management of deep recalcitrant fungal keratitis.
Twelve eyes of twelve patients with deep stromal recalcitrant fungal keratitis not responding to topical 5% natamycin therapy were evaluated.The smear for KOH/ Gram stain for fungus was positive in all cases. Topical voriconazole 1 % along with intrastromal injection of voriconazole were given. Voriconazole 50 micrograms/0.1 ml was injected circumferentially around the fungal abscess in the corneal stroma along five meridians.The main outcome measures were a reduction in size of the abscess and resolution of the infection.
Before the intracorneal injection, all eyes had gradually worsening lesions on topical 5 % natamycin . After the intrastromal voriconazole injection complete resolution of the ulcers occured after 17+/- 3.9 days.The organisms isolated were Aspergillus species in 4 eyes and Fusarium species in 2 eyes . The visual acuity was less than 1/60 at the time of presentation which improved to better than 3/60 in all eyes and better than 6/60 in 8 out of 12 eyes .
Targeted delivery of voriconazole by intracorneal injection may be a safe and effective way to treat cases of deep-seated recalcitrant fungal keratitis responding poorly to conventional treatment modalities.
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