Combination treatment shows promise for recalcitrant Fusarium keratitis

Cornea. 2011;30(8):872-875.

The combination of intrastromally injected and topical voriconazole showed effectiveness in combating infection in patients with Fusarium keratitis, a study found.

"Delivery of voriconazole directly to the site of action by an intrastromal injection increases the drug concentration above minimal inhibitory concentration of most of the Fusarium species and can change the course of the disease from serious to a favorable outcome," the study authors said.

The interventional case series included three patients who presented with recalcitrant Fusarium fungal keratitis. A voriconazole solution was administered to each patient via intrastromal injection along with 5% topical natamycin hourly and oral ketoconazole twice per day. If the ulcer was unresponsive, 1% topical voriconazole was added to the therapeutic regimen.

A drastic reduction in the size of the Fusarium infiltration was observed in two of the patients. While the combination voriconazole treatment reduced the size of the infiltration in the third patient, who had a chemical burn superinfected with the Fusarium organism, the infected eye developed epithelial toxicity and later micro-perforated at the center of the ulcer. The micro-perforation was sealed with an amniotic membrane transplantation and cyanoacrylate glue.