Intrastromal Voriconazole For the Treatment of Recalcitrant Fungal Corneal Ulcer

Abstract

Objective: To asses the efficiency of Voriconazole as an intrastromal adjuvant in treating deep fungal corneal ulcers, Methods: This interventional study was conducted in the department of Ophthalmology, Peoples University of Medical and Health Sciences_ Nawabshah. on fifty eyes of 50 diagnosed patients of deep fungal corneal ulcers, inducted from Out Patient Department of PMC Hospital Nawabshah. The patients were divided into two equal groups A and B, each comprising of 25 cases. In group A inj. Voriconazole 200mg reconstituted to 50 ug/ 0.1 ml was injected around the ulcer in all four quadrants in all 25 cases who were not responding to conventional medical treatment. On the other hand Group B having 25 patients ofdeep fungal corneal ulcers were continued on conventional medical therapy. Results: The efficacy and response was measured as reduction in the size of ulcer and stromal infiltration. It was found that in group A out of 25 patients 18 responded well to inj. Voriconazole while 5 cases ended up in corneal perforation and 2 in endophthalniitis. On the contrary in group B out of 25 patients with conventional antifungal therapy 8 patients responded to treatment while 15 ended up in corneal perforation, and 2 were treated with conjunctival / Amniotic graft. Conclusion: Due to wide range of spectral activity against fungal microbes and least toxic effects, Intrastromal Voriconazole is an encouraging mode of therapy to treat deep recalcitrant fungal corneal ulcers.