# Intracameral voriconazole for severe fungal keratitis: a case series

## TL;DR

This case series explores the use of intracameral voriconazole as an additional treatment for severe fungal eye infections.

## Contribution

The study introduces intracameral voriconazole as a feasible adjuvant treatment for deep fungal keratitis.

## Key findings

- Intracameral voriconazole was administered safely up to four times in 72 hours without complications.
- Fungal eradication was achieved in all patients, but three required therapeutic keratoplasty.
- Final visual acuity outcomes remained poor, with all patients having counting fingers or worse vision.

## Abstract

This study aimed to report the use, efficacy, and safety of intracameral
voriconazole as an adjuvant treatment for deep fungal keratitis.

This was a prospective case series of seven eyes with fungal keratitis with
anterior chamber involvement or a corneal ulcer refractory to conventional
topical treatment. In addition to topical treatment with 0.15% amphotericin
B eye drops, voriconazole 50 µg/ 0.1 mL was administered to the
anterior chamber of each affected eye up to four times within 72 h. The
primary outcome measures were healing (fungal eradication) and the need for
therapeutic keratoplasty. Best-corrected visual acuity was a secondary
outcome measure.

Three cases were confirmed by confocal microscopy, and four were diagnosed
from positive culture tests. At presentation, one patient had a
best-corrected visual acuity of 20/80, while all others had hand motion or
worse. Four cases received one intracameral injection, two cases received
three, and one case received four injections. There were no complications
after any of the intracameral voriconazole injections. Four patients had
imminent corneal perforations and were treated with cyanoacrylate adhesive
and bandage contact lenses. Four patients recovered from the infection, and
three underwent therapeutic keratoplasty. The final best-corrected visual
acuity was improved in two cases but all patients had a final visual acuity
of counting fingers or worse.

As an adjuvant treatment for deep fungal keratitis, intracameral voriconazole
injection is a feasible option. Although fungal eradication was achieved in
all patients, three required therapeutic keratoplasty and all patients had
unsatisfactory visual acuity outcomes.