Intracameral and topical voriconazole for fungal corneal endoexudates

To evaluate the role of intracameral and topical voriconazole as treatment for fungal keratitis presenting with endothelial exudates.

Five eyes of 5 patients with fungal keratitis presenting with endoexudates with or without infiltrates in the corneal stroma were included in the study. Intracameral voriconazole 50 mcg/0.1 mL was given followed by topical voriconazole 1% hourly. Main outcome measure was Resolution of endoexudates and corneal stromal infiltrates.

On presentation, all 5 eyes had endoexudates. Diagnosis of fungal keratitis was based on microbiological analysis of endoexudates (3 eyes) and corneal scrapings (2 eyes). After the intervention, the reduction in the size and density of endoexudates were documented and a complete resolution of the infection was seen in all cases within 3 weeks to 3 months. Two patients experienced burning sensations with topical voriconazole. Best-corrected visual acuity (BCVA) at presentation was hand motions in 3 patients and less than 20/125 in the remaining 2 patients. Final BCVA varied from 20/2000 to 20/40 depending on location of corneal scar.

Intracameral and topical voriconazole may be effective against deep fungal keratitis presenting with endoexudates.