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Abstract
Purpose
To evaluate the efficacy of topical voriconazole in treatment of culture-positive fungal keratitis.
Methods
Twenty-two cases of culture-positive fungal keratitis treated with topical anti-fungal drugs from October 2004 to December 2010 were evaluated and medical records were reviewed. Patients were divided into 3 groups according to the method of topical antifungal treatment; the first group (V, n = 6) received voriconazole monotherapy, the second group (V+, n = 10) received topical voriconazole and amphotericin B combined therapy, and the third group (A, n = 6) received amphotericin B monotherapy.
Results
The treatment success rate between the 3 groups was not significantly different. The epithelial defect healing time of group V was shorter than group V+. Treatment failure risk factors included Fusarium spp. infection and the presence of hypopyon. Eight eyes received topical voriconazole maintenance therapy for 66 days and there were no corneal erosions or epithelial defects.
Conclusions
In fungal keratitis, topical voriconazole is as effective as other standard treatments and provides a faster healing time in the corneal epithelium than other standard treatments. However, voriconazole should be used with caution and therapeutic surgery should be considered in Fusarium spp. infections.
Figures and Tables
Figure 1
Area measured by Image J software. Using the anterior segment photograph, the area was measured by marking the margin. We calculate the ratio of the epithelial defect area to the entire corneal area.
Figure 2
(A, B) Fungal keratitis resulting from Candida spp. (C, D) After 5 days of 1% voriconazole every 1 hr monotherapy. Corneal inflammation and epithelial defects decreased. (E, F) After 30 days of 1% voriconazole every 1 hr monotherapy, the infection regressed.
Figure 3
(A, B) Fungal keratitis resulting from Candida spp. and S. pneumonia (C, D) After 24 days of 1% voriconazole every 1 h monotherapy, the infection regressed. (E, F) After 2 weeks of 1% voriconazole after regression. There was no toxicity of the corneal epithelium.
Table 3
Comparison of patient characteristics and treatment outcome between the treatment groups
DM = diabetes mellitus; PKP = penetrating keratoplasty.
*Topical voriconazole monotherapy group; †Topical voriconazole and amphotericin B combined therapy group; ‡Amphotericin B monotherapy group; §Fusarium and Acremonium co-infection regard as Fusarium group; ΠFisher's exact test; #Mann-Whitney U test.
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