Adjunctive Topical Calcineurin Inhibitors During the Treatment of Fungal Keratitis: Practice Patterns and Opinions

Successful antifungal treatment for fungal keratitis does not always result in a good visual outcome. Both infectious and inflammatory components of the disease result in visually significant corneal opacification. We conducted a survey of cornea specialists to elicit expert opinion on the role topical calcineurin inhibitors may play in the management of fungal keratitis.

An online survey was sent to subscribers of several cornea-focused listservs. Descriptive statistics were performed.

One hundred thirty-five participants completed the online survey. Approximately 48% of respondents practiced medicine in the United States and 36% in India. About 23% presently "sometimes" prescribe topical calcineurin inhibitors. And 70% never prescribe. When administered adjunctively to topical antifungal drops, 59% of respondents predict 1% to 2% topical cyclosporin would have a clinically significant antiinflammatory effect compared with 33% for the 0.05% to 0.1% cyclosporin dose. About 50% believe the 0.1% tacrolimus dose would have a clinically significant antiinflammatory activity compared with the 0.03% tacrolimus dose. Overall, those surveyed predicted adjunctive topical calcineurin inhibitors could improve final visual acuity by almost one line of vision.

Varied opinions exist regarding the role adjunctive topical calcineurin inhibitors can play during a treatment course of fungal keratitis. The overall impression is that these agents may help clinical outcome.