Back to Journals » Clinical Ophthalmology » Volume 8

Ineffectiveness of intrastromal voriconazole for filamentous fungal keratitis

Authors Niki M, Eguchi H, Hayashi Y, Miyamoto T, Hotta F, Mitamura Y

Received 4 March 2014

Accepted for publication 15 April 2014

Published 5 June 2014 Volume 2014:8 Pages 1075—1079

DOI https://doi.org/10.2147/OPTH.S63516

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 6


Masanori Niki, Hiroshi Eguchi, Yuki Hayashi, Tatsuro Miyamoto, Fumika Hotta, Yoshinori Mitamura

Department of Ophthalmology, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima-shi, Japan

Purpose: The purpose of this study is to describe the ineffectiveness of intrastromal voriconazole injection for filamentous fungal keratitis by contrasting the effectiveness for yeast keratitis.
Methods: We examined seven fungal keratitis patients prospectively. All yeast was identified by molecular phylogenetic analyses of the chromosomal regions coding for the D1/D2 domain of the large-subunit 26S ribosomal RNA gene. All filamentous fungi were identified by the sequencing of internal transcribed spacers of the ribosomal DNA gene regions. Approximately 0.1 mL of voriconazole diluted with saline to 1.0% was injected with a 30-gauge needle inserted obliquely into the three to five clear cornea sites around the abscess. All subjects were administered natamycin ointment and oral itraconazole. When needed, intravenous micafungin, voriconazole, and/or intracameral voriconazole were added. Clinical courses were observed by the slit lamp microscope. Histopathology was examined when the corneas were removed.
Results: All cases that were caused by yeast healed quickly after injections. Two cases of keratitis caused by Fusarium, and one case caused by Aspergillus, did not heal completely. In the Fusarium cases, additional antifungal medications (3.0% topical voriconazole and intravenous injection of micafungin) were needed. After optical penetrating keratoplasty in one of the cases, fungi were found in the deep stroma of the removed cornea. In the case of Aspergillus keratitis, pathological findings also showed fungi deep in the stroma of the removed cornea and the keratitis recurred after therapeutic penetrating keratoplasty.
Conclusion: Intrastromal voriconazole injection is successful in treating yeast keratitis. However this is not the case for filamentous fungal keratitis.

Keywords: voriconazole, intrastromal injection, filamentous fungal keratitis

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]