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Impression cytologic evaluation of conjunctiva in patients treated with 1% topical voriconazole

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First Author: C.Değirmenci TURKEY

Co Author(s):    C. Değirmenci   M. Palamar   Z. Yıldırım Ekin   Ö. Barut Selver   A. Veral   A. Yağcı     

Abstract Details

Purpose:

Voriconazole is a broad-spectrum triazole antifungal drug which is available in oral and parenteral formulations, and currently is indicated for treatment of invasive aspergillosis, Fusarium spp., and severe Scedosporium spp. infections. In ophthalmology practice it can be used via topical, intrastromal, intracameral or intravitreal routes for fungal infections. Topical voriconazole reaches therapeutic concentration in 24 minutes in humour aqueous. However, in recent articles it was reported to cause conjunctival squamous metaplasia. The aim of the present study was to evaluate any conjunctival metaplastic changes by impression cytology in patients who underwent voriconazole treatment for severe fungal keratitis.

Setting:

The study was conducted at Ege University School of Medicine, Departments of Ophthalmology and Medical Pathology. (Project number:18-TIP-005)

Methods:

Twenty four patients who were treated with 1% topical voriconazole for fungal keratitis for at least 3 months were included. The used topical voriconazole treatment was initiated as a drop in every hour and was tapered according to clinical improvement in all patients. The treatment was maintained as 4 times a day for at least 3 months. Samples for impression cytology were collected at least 3 months after cessation of topical voriconazole from the effected eye (study group) and from the contralateral eye (control group). Collected specimens were transferred to pathology department for evaluation and grading (Nelson’s grading system).

Results:

Mean age of the patients was 57.68±17.32 (12-87) years. The impression cytology grade of the inferior bulber conjunctiva was 1.73±0.77 (0-3) in the study group and 1.19±098 (0-3) in the control group (p=0.03). The impression cytology grade of the temporal bulber conjunctiva was 1.69±073 (0-3) in the study group and 1.15±0.88(0-3) in the control group (p=0.02). The impression cytology grades of nasal and superior bulber conjunctiva of the groups were not statistically significant (p values 0.13, 0.172, respectively).

Conclusions:

Topical voriconazole is an effective broad spectrum antifungal drug, however it induces conjunctival squamous metaplasia. Clinicians should be aware of this possible side effect of topical voriconazole and should carefully evaluate conjunctiva of treated patients in every visit to detect possible metaplastic changes.

Financial Disclosure:

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