Posters

Dramatic and rapid response to intracameral voriconazole for fungal keratitis

Poster Details

First Author: Ü. Çalli TURKEY

Co Author(s):    T. Ayyildiz   B. Kandemir                 

Abstract Details

Purpose:

The purpose of this report is to describe dramatic and rapid response to intracameral voriconazole injection for fungal keratitis in a patient.A 26-year-old female was referred to our clinic due to progressive keratitis unresponsive to treatmeant.At presentation, she had very low visual acuity (hand motion) and a painful red eye. The patient was already treated with topical fortified cefazol, genta and amphotericin B and cyclopentolate 1%.

Setting:

Kartal Dr. Lütfi Kırdar Research and Training Hospital Clinic of Ophtalmolgy, Istanbul, Turkey

Methods:

On examination, the patient had severe conjunctival injections and chemosis, a large corneal stromal opacity and endothelial plaque (only approximatetly 2 mm clear cornea), 4 mm hypopyon and moderate flare in anterior chamber and a large epithelial defect.The patient was initially treated with topical fortified vancomycin (50 mg/ml), amikacin (33 mg/ml), voricanazol (10 mg/ml), natamycin ophthalmic ointment 5% and cyclopentolate 1%, systemic oral itraconazole 400 mg on day 1, then 200 mg daily.After one week, the response to treatment was insufficient.On the 7th day of the treatment we decide to perform intracameral voriconazole.

Results:

An informed consent was signed by the patient.In the operating room and under aseptic conditions, cultures specimens were acquired from aqueous fluid.Using a 1-ml tuberculin syringe attached to a 30-G needle, intracameral 0.1 ml of voriconazole (50 μg/0.1 ml) was injected.Three days postinjection, there was a significant decrease in eyelid edema, ocular pain, corneal stromal opacity and endothelial plaque, hypopyon and the epithelial defect (figure 1). On the 3rd postinjection day intracameral voriconazole repeated.The response to second intracameral injection was dramatic (figure 2).After three days from the second injection we performed penetrating keratoplasty (figure 3).On the first day of the keratoplasty visual acuity was 0.4.Six months later, the cornea was clear, no recurrence was noted.

Conclusions:

Fungal keratitis is a vision-threatening infectious disease and have a worse prognosis than bacterial keratitis.Early diagnosis and targeted treatment for fungal keratitis is the key to managing the disease.Natamycin is the most commonly used topical treatment followed by amphotericin.Although natamycin, the only commercially available antifungal agent for ophthalmic use, is effective in eliminating both yeast and filamentous fungi, in some cases its effective is limited.Voriconazole has been reported to have a broad-spectrum of anti fungal properties.Intraocular use of voriconazole in treating fungal keratitis is an off-label use.This modality of treatment might be used in severe cases of fungal keratitis.

Financial Disclosure:

NONE