Korean J Ophthalmol.  2009 Mar;23(1):46-48. 10.3341/kjo.2009.23.1.46.

Topical and Oral Voriconazole in the Treatment of Fungal Keratitis

• Lee SJ
• Lee JJ
• Kim SD

• KMID: 1115652
• DOI: http://doi.org/10.3341/kjo.2009.23.1.46

Abstract

We describe two patients with fungal keratitis refractory to standard antifungal therapy whose conditions were managed with voriconazole. The first case is a patient with endophthalmitis and corneal ulcer due to Candida parapsilosis after receiving a corneal transplant. The patient was treated with amphotericin but showed no signs of improvement. Topical voriconazole, oral voriconazole, and intravitreal voriconazole yielded signs of improvement. The second case is a 63-year-old male who underwent a month of empiric treatment with 0.2% topical amphotericin for fungal keratitis but showed no signs of improvement. Treatment was then provided with 1% voriconazole. Both cases showed effective treatment with voriconazole. Voriconazole may be considered as a new method to treat fungal keratitis refractory to standard antifungal therapy.

Keyword

Fungus; Keratitis; Voriconazole

MeSH Terms

Administration, Oral
Antifungal Agents/*administration & dosage
Candidiasis/diagnosis/*drug therapy/microbiology
Cornea/microbiology/pathology
Diagnosis, Differential
Dose-Response Relationship, Drug
Eye Infections, Fungal/diagnosis/*drug therapy/microbiology
Follow-Up Studies
Humans
Keratitis/diagnosis/*drug therapy/microbiology
Male
Middle Aged
Ophthalmic Solutions
Pyrimidines/*administration & dosage
Triazoles/*administration & dosage

Figure

• 

  Fig. 1 (A) Approximately 1 year later, anterior chamber hypopyon and vitreous opacity on B-scan were observed. (B) After the patient was treated with 1% topical voriconazole for 6 weeks the corneal lesion and endophthalmitis improved. The corneal opacity persisted as a complication of the lesion and endophthalmitis. (C) The patient underwent another penetrating keratoplasty and showed a visual acuity of 0.1 at follow-up. There was no sign of recurrence.

• 

  Fig. 2 (A) On initial examination, a feathered corneal infiltration and a corneal ulcer were observed. (B) After 10 days the corneal epithelial appeared healed; however, there was no change in the corneal infiltration. (C) After 13 weeks we observed complete healing of the corneal epithelium and resolution of the corneal infiltrate; however, the corneal opacity persisted.

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