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Severe fungal keratitis treated with subconjunctival fluconazole
1Department of Ophthalmology, Izmir Atatürk Training and Research Hospital, M. Kemal Cad. NO: 36/4, 35040 Bornova, Izmir, Turkey. safiyekucukbay@hotmail.com
American Journal of Ophthalmology
|July 20, 2005
Summary
Subconjunctival fluconazole shows promise as a safe and effective treatment for severe fungal keratitis unresponsive to standard therapies. This approach may help avoid surgery in acute stages of the infection.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Pharmacology
Background:
- Severe fungal keratitis often presents challenges in treatment, especially when refractory to conventional antifungal medications.
- Standard therapies including topical and systemic fluconazole, and oral itraconazole, may not always yield successful outcomes.
- Alternative treatment strategies are crucial for managing resistant cases and preventing vision loss.
Purpose of the Study:
- To evaluate the efficacy and safety of subconjunctival fluconazole as an alternative therapy for severe fungal keratitis.
- To determine if this treatment can be an effective option for patients who have not responded to conventional antifungal treatments.
- To assess the potential of subconjunctival fluconazole in avoiding surgical interventions during the acute phase of infection.
Main Methods:
- A prospective, interventional case series was conducted.
- Thirteen patients with severe fungal keratitis, resistant to prior antifungal treatments, received subconjunctival fluconazole injections (2%, up to 1.0 mL) twice daily for at least 5 days.
- Treatment duration was extended if necessary, with daily injections for up to 14 days.
Main Results:
- Six out of thirteen eyes achieved successful treatment within 5 days of subconjunctival fluconazole injections.
- Seven patients required extended or repeated injections, with one ultimately undergoing evisceration.
- Final visual acuity was influenced by scar location, necessitating corneal transplantation in four cases.
- No local or systemic toxic side effects were observed during the study.
Conclusions:
- Subconjunctival fluconazole appears to be a safe and effective treatment for severe fungal keratitis, particularly in cases with hypopyon.
- This therapeutic approach may offer a valuable alternative to surgical intervention in the acute phase of fungal corneal infections.
- While specific optimal dosing requires further investigation, the administered dose demonstrated safety and efficacy.
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