Related Experiment Video
Updated: Aug 14, 2026

Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis
Published on: November 12, 2015
Voriconazole in the management of Alternaria keratitis
Zeynep Ozbek1, Sheila Kang, Jocelyn Sivalingam
1Cornea Service, Wills Eye Hospital, Philadelphia, Pennsylvania 19107, USA.
Purpose:
To discuss the role of voriconazole in the management of Alternaria keratitis.
Methods:
Case report and literature review.
Results:
A 69-year-old man with a history of corneal foreign body removal developed a stromal infiltrate 2 months later that did not improve despite topical antibiotics and natamycin. On our initial examination, visual acuity (VA) was 20/40, and he had a central, full-thickness, reticular appearing infiltrate. Oral clarithromycin was added because of the atypical pattern of the infiltrate. However, no improvement was noted. A repeat culture revealed coagulase-negative Staphylococcus. VA decreased to 20/200, and increased inflammation was noted a month later; a trial of topical steroids was added. After an initial improvement, he returned with progression. Repeat culture revealed Alternaria species, and topical amphotericin was started. When there was no response, he was admitted and switched to oral and topical voriconazole. Steady resolution was noted within 10 days of therapy.
Conclusion:
Suspicion must be maintained for unusual causes of infectious keratitis. Fungal infection can be difficult to eradicate even with traditional antifungals. Although not approved for ophthalmic use yet, voriconazole provided improvement with Alternaria keratitis unresponsive to amphotericin.
Related Concept Videos
Antifungal Agents
Candidiasis
Cryptococcal Meningitis
Open Angle Glaucoma: Treatment
Drugs such as carbonic anhydrase inhibitors, α2- and...
Angle Closure Glaucoma: Treatment
Endocarditis III: Medical Management