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Study: Voriconazole eye drop formulation may be effective for treating fungal keratitis
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A formulation of voriconazole eye drops appears effective, well-tolerated and capable of reaching adequate aqueous humor levels for treating refractory fungal keratitis, according to a prospective study by researchers in Australia, published in the March issue of Archives of Ophthalmology.
"This preparation is likely to have a valuable role in the therapeutic management of Candida and Aspergillus keratitis. It is substantially more affordable than oral therapy and has less potential to cause systemic adverse effects," the authors said.
Mervyn Ferdinands, MBBS(Hons), and colleagues randomly assigned 10 patients with refractory fungal keratitis to receive a 1% solution of Vfend (voriconazole, Pfizer) in one of two dosing regimens before performing routine anterior segment surgery.
Specifically, the researchers administered a 1% solution of voriconazole, preserved with 0.01% benzalkonium chloride, to five patients every 6 hours for 3 days and to five patients in 4 hourly preoperative doses.
During the anterior segment procedure, the surgeons used a 30-gauge needle attached to a syringe to aspirate 0.1 mL to 0.2 mL of aqueous humor through a paracentesis site before infusing irrigation solution. Aqueous humor samples were then refrigerated at 4°C, and the researchers used validated high-performance liquid chromatography to determine voriconazole levels.
The mean voriconazole concentration after hourly dosing before surgery was 1.9 µg/mL. The mean voriconazole concentration after a single dosing preoperatively every 6 hours was 0.94 µg/mL.
The mean sampling times after the last administration of eye drops were 1.1 hours after hourly dosing and 2.1 hours after a single dosing every 6 hours, according to the study.
The surgeons administered a total of 80 eye drops, with each patient receiving between 2 mg and 6 mg, or "about 1% to 3% of the usual daily oral dose," the authors noted.
"Five participants reported no adverse reaction, three reported one instance of stinging, one reported two instances of stinging, and one reported sneezing and coughing after the initial dose," they added.