Evaluation of intrastromal injection of voriconazole as a therapeutic adjunctive for the management of deep recalcitrant fungal keratitis

PURPOSE: To evaluate the role of intrastromal injection of voriconazole in the management of deep recalcitrant fungal keratitis. DESIGN: Interventional case series. METHODS: SETTING: Cornea services at a tertiary care teaching hospital. PATIENTS: Three eyes of three patients with deep stromal recalcitrant fungal keratitis not responding to topical antifungal medications. INTERVENTION PROCEDURE: Voriconazole 50 micrograms/0.1 ml was injected circumferentially around the fungal abscess in the corneal stroma as an adjunctive to the topical antifungal therapy. MAIN OUTCOME MEASURE: Main outcome measure was a reduction in size of the abscess and resolution of the infection. RESULTS: Before the intracorneal injection, all three eyes had gradually worsening lesions on topical medications. After the intervention, a faster reduction in the size of corneal infiltration was documented and a complete resolution of the ulcers was seen within three weeks in all cases. 0 CONCLUSION: Targeted delivery of voriconazole by intracorneal injection may be a safe and effective way to treat cases of deep,seated recalcitrant fungal keratitis responding poorly to conventional treatment modalities.