Efficacy of 0.5% Voriconazole Subpalpebral Lavage as Adjunctive Therapy: A Multicenter Prospective Study in Fungal...

To evaluate the efficacy of subpalpebral ocular continuous lavage (SOCL) with 0.5% voriconazole combined with systemic antifungals (SOCL+M) versus systemic antifungals alone (M) in fungal keratitis.

This was a multicenter, prospective, non-randomized trial with masked outcome assessment. Treatment allocation-to either subpalpebral 0.5% voriconazole lavage combined with systemic antifungals or systemic antifungals monotherapy-was determined by patient preference and physician recommendation. The study protocol was standardized across sites through centralized training and adherence was monitored with monthly audits. The primary outcome was 3-month cure rate; secondary outcomes included penetrating keratoplasty (PKP) rate, hypopyon resolution time, and corneal parameter changes over one month.

Compared to the M group, the SOCL+M group exhibited a significantly higher cure rate (69.0% vs. 40.7%; OR = 3.23, 95% CI: 1.49-7.03, p = 0.003) and a lower rate of penetrating keratoplasty (0% vs. 10%, p = 0.027) at the 3-month follow-up. The hypopyon resolution time occurred more rapidly in the SOCL+M group (6.79 ± 3.36 days vs. 10.06 ± 3.62 days, p = 0.009). Furthermore, the SOCL+M group showed significantly greater reductions in corneal infiltration, epithelial defect, and fungal density at 1 month compared to the M group (all p < 0.05).

SOCL represents an innovative adjunctive therapy for fungal keratitis, offering significant clinical advantages including accelerated corneal healing, higher cure rates, and reduced need for therapeutic keratoplasty, with strong translational potential.