Cornea and External Disease

Study compares 3 intrastromal injections for recalcitrant fungal keratitis

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Intrastromal voriconazole (IS-VCZ), amphotericin B (IS-AMB) and natamycin (IS-NTM) are safe and effective as an adjunct to conventional therapy in patients with recalcitrant fungal keratitis, according to a study.

In this prospective randomized trial, 60 patients (60 eyes) with recalcitrant fungal keratitis who were not responding to topical natamycin (NTM) therapy for 2 weeks, were randomized to receive ISVCZ 50ug/0.1 mL (n = 20), ISAMB, 5ug/0.1 mL (n = 20), and ISNTM 10ug/0.1 mL (n = 20), in addition to continued topical NTM 5% every 4 hours until the ulcer healed.

Baseline parameters were similar in all groups. Compared to the ISVCZ group and the ISAMB group, mean duration of healing was significantly better in the ISNTM group.

In the ISVCZ and ISNTM groups, approximately 95% of patients healed successfully, whereas approximately 90% did in the ISAMB group. Deep vascularization was significantly greater in the ISAMB group compared to the other groups. Fewer repeat injections were needed in the ISNTM group compared to the other groups.

“The 3 intrastromal injections are comparable in efficacy and treating ophthalmologists can choose from any of these as an adjunct to conventional therapy for recalcitrant fungal keratitis,” the authors concluded.

Saluja G, Sharma N, Agarwal R, et al. Comparison of safety and efficacy of intrastromal injections of voriconazole, amphotericin B and natamycin in cases of recalcitrant fungal keratitis: A randomized controlled trial. Clin Ophthalmol. 2021;15:2437—2446.

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