Successful Treatment of Postkeratoplasty Fungal Keratitis with Topical and Intrastromal Voriconazole
|Maja Pauk-GuliÄ1, Nikica GabriÄ1, Alma BišÄeviÄ1, Adi PašaliÄ1 and Iva Dekaris2*|
|1Department of Ophthalmology, University of Rijeka, Zagreb, Croatia|
|2University Eye Hospital ‘Svjetlost’, Croatia|
|Corresponding Author :||Iva Dekaris
University Eye Hospital ‘Svjetlost’
Heinzelova 39, 10000 Zagreb, Croatia
E-mail: [email protected]
|Received November 20, 2014; Accepted February 02, 2015; Published February 05, 2015|
|Citation: Pauk-Gulic M, Gabric N, Bišcevic A, Pašalic A, Dekaris I (2015) Successful Treatment of Postkeratoplasty Fungal Keratitis with Topical and Intrastromal Voriconazole. J Clin Exp Ophthalmol 6:393. doi: 10.4172/2155-9570.1000393|
|Copyright: © 2015 Dekaris I, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.|
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Objective: Corneal grafts have a major risk of fungal keratitis due to long-term local and sometimes systemic steroid/antibiotic use. The aim of this study was to evaluate the efficacy of intrastromal voriconazole as a therapeutic adjunctive for the management of fungal keratitis in corneal graft.
Design: Presentation of two cases of fungal keratitis occurring after corneal transplantation and treated at the University Eye Hospital “Svjetlost”.
Participants and Methods: Two cases of postkeratoplasty fungal keratitis are presented in the study. Both patients had decreased visual acuity, eye redness and severe pain occurring at 10 and 12 months after uneventful corneal transplantation. They were still receiving steroid/antibiotic topical treatment to protect their corneal graft. Patients presented with a stromal infiltrate in a donor tissue, accompanied with corneal ulcer at recipient/donor junction. Candida infection was proven by corneal scraping. Topical and systemic antimycotic treatment was started, fortified by intrastromal injection of voriconazole (50 μg/0.1 ml) given all around the junction of clear cornea and infiltrate (or ulcer).
Results: One week after injection, corneal ulcers had healed and corneal infiltrates decreased; resulting in visual acuity improvement from 20/100 to 20/20 in first, and from 20/80 to 20/40 in a second case. One year after infection visual acuity in the first case remained 20/20, and improved to 20/20 in a second case. Conclusion: Intrastromal voriconazole seems to be a safe method for providing a higher concentration of the drug in the cornea affected by fungal keratitis; it can serve as an adjunctive treatment to topical and systemic antifungal therapy.