Repeated Intrastromal Injections of Voriconazole in Combination with Corneal Debridement for Recalcitrant Fungal Keratitis – a Case Series

Abstract

Background: To report the use of intrastromal voriconazole injections combined with corneal debridement to treat deep recalcitrant fungal keratitis. History and Signs: Three patients (2 female and 1 male) with culture proven fungal keratitis (1 Fusarium, 1 Candida, 1 Pseudallescheria boydii) were included in this study. The patients were treated with repeated intrastromal voriconazole (100 mg/1 ml) in combination with corneal debridement. Therapy and Outcome: The mean age of the patients was 65 years. The mean number of injections was 5. The patients were injected every 2–3 days. This technique required repeated corneal debridement to achieve complete resolution in these three cases. Conclusions: Repeated intrastromal injection of voriconazole in combination with corneal debridement appears to be an effective and safe way to treat recalcitrant fungal keratitis, even in Fusarium keratitis.

Zusammenfassung

Hintergrund: Ziel der Studie war es, die Wirksamkeit intrastromaler Voriconazol Injektionen und Hornhaut-Debridement bei der Behandlung resistenter Pilzinfektionen zu überprüfen. Anamnese und Befunde: Insgesamt wurden drei konsekutive Patienten (2 Frauen, 1 Mann) mit gesicherter Pilzkeratitis (1 Fusarium, 1 Candida, 1 Pseudallescheria boydii) in diese Studie eingeschlossen. Die Patienten wurden mit wiederholten intrastromalen Injektionen mit Voriconazol (100 mg/1 ml) behandelt. Therapie und Verlauf: Das Durchschnittsalter der Patienten betrug 65 Jahre. Im Durschnitt wurden 5 Injektionen im Abstand von 3 Tagen durchgeführt. Bei allen Patienten war die Behandlung (d. h. wiederholte Injektionen und Abkratzen der Hornhaut) erfolgreich. Schlussfolgerungen: Intrastromale Injektionen scheinen eine sichere und effektive Option bei der Behandlung resistenter Pilzkeratiden (sogar bei Fusarium Keratitis) zu sein.

Key words

voriconazole - VFend - fungal keratitis - intrastromal injection

Schlüsselwörter

Voriconazol - VFend - Pilzkeratitis - intrastromale Injektionen

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