Corneal Debridement Combined with Intrastromal Voriconazole for Recalcitrant Fungal Keratitis

Background. To analyze the therapeutic effects of corneal debridement combined with intrastromal voriconazole in recalcitrant fungal keratitis. Methods. This is a retrospective study. Fourteen patients with recalcitrant fungal keratitis were treated by corneal debridement combined with intrastromal voriconazole (50 mu g/0.1 ml). This paper reviews and analyzes the patients' basic state, surgical intervention, medicinal treatment, and outcomes. Results. The mean sizes of infiltration and ulcer were (5.54 +/- 1.32) mm and (3.46 +/- 1.03) mm, respectively, and the mean depth was (315.43 +/- 57.72) mu m. Twelve of the patients had satellite lesion, and 2 suffered hypopyon. After intrastromal voriconazole, the size of infiltration decreased significantly to (4.32 +/- 1.10) mm (P < 0 001), but there was no significant change in ulcer size ((3.36 +/- 0.92) mm, P = 0 082). Thirteen patients were cured after corneal debridement. The mean healing time was (15.38 +/- 7.38) days. Excluding one cured patient with optic nerve atrophy and one patient for whom the treatment failed, the mean best-corrected visual acuity after healing was (0.23 +/- 0.18) LogMAR, a significant improvement compared to pretreatment (0.87 +/- 0.57(LogMAR), P = 0 01). The mean corneal astigmatism was (1.3 +/- 1.6) D of 12 cured patients after healing and (1.0 +/- 0.7) D at final follow-up, and there was no significant difference (P = 0 374). Conclusions. Corneal debridement combined with intrastromal voriconazole is a secure and effective treatment for recalcitrant fungal keratitis.