CLINICAL EVALUATION OF INTRASTROMAL VORICONAZOLE IN RECALCITRANT FUNGAL KERATITIS A PROSPECTIVE STUDY AT SAROJINI DEVI EYE HOSPITAL, HYDERABAD
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2015, Vol 4, Issue 55
Abstract
[b] BACKGROUND[/b]: Recalcitrant Fungal keratitis is a common ocular infection leading to visual impairment. [b]OBJECTIVES:[/b] To evaluate the efficacy of intrastromal Voriconazole in Recalcitrant Fungal keratitis. [b]MATERIALS AND METHODS:[/b] This was an interventional study in department of Cornea, Sarojini Devi Eye Hospital, Osmania Medical College, Hyderabad over a period from Feb.2013 Feb.2014. 30 Patients of Fungal Keratitis not responding to routine topical and systemic antifungal therapy in 7 to 14 days, which were diagnosed as Recalcitrant fungal keratitis were given 5µgms/0.1ml of voriconazole intrastroml injections around the fungal infiltrates in a grid pattern. Details of patients age and sex, type of causative fungal and traumatic agents, size of corneal ulcer, presence of Hypopyon or not, and time taken for hypopyon absorption, and clinical improvement and resolution of the ulcer and visual acuity were noted. [b]RESULTS[/b]: This study group of 30 patients diagnosed as Recalcitrant fungal keratitis showed Causative Fungi as Fusarium in 19(63.0%), Aspergillus in 11(37.0%). Causative Traumatic Agents were vegetative matter in 19 (63.3%), other agents in 8(26.7%) and not known in 3(10.0). 17(56.7%) were Males with 13(43.3%) Females. Age wise distribution was 3(10.0%) in>10-20yrs, 11(36.7%) in 20–40 yrs, 15(50.0%) in 40-60 yrs, and 1(3.3%) in >60 yrs. The size of the ulcer showed <1/2 of the cornea in 21(70.0%) and >1/2 of the cornea in 9(30.0%). 19 (63.3%) were with hypopyon and 11(36.7%) without hypopyon. After Intrastromal Voriconazole, the absorption of Hypopyon in 12 (63.2%) was in 2to 4 wks. and in 2(10.5%) in > 4 wks. Clinical improvement of the Fungal Corneal Ulcer was seen in no case (0.0%) in <1st wk., in 24(80.0%) in 2 to 4wks and in 2(6.7%) in > 4 wks. Time (wks.) of healing of the Fungal Corneal Ulcer was in 4-6wks in 21 (70.0%) and in >6wks in 5(16.7%). Visual Acuity was <3/60 in 2(7.7%), 3/60-<6/60 in 10(33.3%), 6/60-<6/18 in 9(30.0%) and 6/18–6/9 in 5(16.7%). [b]CONCLUSION:[/b] Common causes of fungal keratitis in Recalcitrant Fungal keratitis were Fusarium in 15(50.0%), Aspergillus in 12(40.0%) and Candida in 3(10.0). Intrastromal Voriconazole has a therapeutic role in resolving recalcitrant fungal keratitis not responding to routine antifungal therapy within 4–6 wks.
Authors and Affiliations
Srinivas Prasad, Ravinder S. , Ananda Kumar, Satyavani P. , Venkata Ratnam, Padmavathi P. , Sai Shreya T. , Doli Anitha Sri
Keywords
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- EP ID EP148765
- DOI 10.14260/jemds/2015/1386
- Views 111
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