Argon Laser Phototherapy as an Adjunctive Treatment for Refractory Fungal Keratitis: A Retrospective Case Series

Background This study aimed to evaluate the safety and clinical efficacy of argon laser phototherapy (ALP) as an adjunctive treatment for refractory fungal keratitis (FK) in a retrospective case series. Methodology This retrospective case series included 10 eyes from 10 patients with culture-proven FK that failed to improve after ≥2 weeks of topical antifungals. All eyes underwent adjunctive ALP (532 nm, 200 µm, 0.1 seconds, 900-1200 mW) applied to the fluorescein-stained ulcer bed until mild stromal blanching/microcavitation was observed. Standard topical antifungals were continued thereafter. The primary outcome was the time to complete epithelial healing with resolution of stromal infiltration. Secondary outcomes were the change in best-corrected visual acuity (BCVA) and adverse events. Minimum follow-up was three months. Results The mean age of the patients was 48.2 ± 11.6 years. Causative organisms included Fusarium (n = 5), Aspergillus (n = 3), and Candida (n = 2). Complete epithelial closure and resolution of infiltration were achieved in nine (90%) eyes within two to four weeks (mean ± SD = 2.6 ± 0.8 weeks). One Fusarium ulcer required amniotic membrane grafting for final closure. The mean BCVA improved from 0.2 to 0.4 (decimal) at final follow-up (p = 0.02). No cases of corneal melting, perforation, endothelial damage, or recurrence were observed during a mean follow-up of 4.2 ± 1.5 months. Conclusions Adjunctive ALP is a safe, effective, and accessible technique for refractory FK. Its combination of localized fungicidal effect and enhanced stromal drug penetration may accelerate healing, improve visual outcomes, and reduce the need for surgical intervention.