Single Intrastromal Voriconazole Injection for Refractory Aspergillus flavus Keratitis

Fungal keratitis is a potentially vision-threatening infection that can be difficult to treat when it involves the deep corneal layers. We report the case of a 50-year-old woman who developed deep central fungal keratitis following vegetative ocular trauma. Microbiological analysis identified Aspergillus flavus (A. flavus). Despite intensive topical treatment with voriconazole 1% and amphotericin B 0.15%, the infiltrate progressed after one week. A single intrastromal injection of voriconazole (50 µg/0.1 mL) was administered circumferentially around the infiltrate. Progressive clinical improvement followed, with complete resolution within one month and no recurrence during two years of follow-up. Final visual acuity was 20/100, with residual corneal scarring. This case highlights the potential role of intrastromal voriconazole as a targeted treatment option for deep, refractory fungal keratitis.