Clinical spectrum and outcome of intrastromal voriconazole in deep recalcitrant mycotic keratitis: A hospital-based study

Abstract

Background: Mycotic keratitis is a potentially blinding corneal infection. Fusarium species are the common cause associated with injury from vegetative matter. Due to low drug penetration, deep recalcitrant cases are still difficult to treat, requiring other strategies such as intrastromal voriconazole. MaterialsandMethods: Aprospectiveinterventionalstudywascarriedoutatatertiarycarehospitalon20patientsbetween2022and2024withnon-responsive deep fungal keratitis. Intrastromal injections of 50 µg/0.1 ml of voriconazole were then administfered to the cases who were not responding to the conventional antifungal treatment. Ulcer size, hypopyon, number of injections, resolution time, and complications were evaluated during follow-up. Results: Agricultural trauma accounts for (85%), of the infection and males are more commonly affected (65%). Common fungus being Fusarium spp (45%), followed by Aspergillus and Scedosporium (20% each). Larger ulcers were associated with increased incidence of complications and delayed healing. Complete resolution took 20–58 days, with a mean of 33.94 ± 10.91 days. Ulcers larger than 6mm 2 in three cases (15%) had ocular perforation. Conclusion: Fusarium spp. is the common cause of deep resistant fungal keratitis. Intrastromal injection should not be delayed in large ulcers and in cases not responding to conventional antifungal therapy. There is a necessity for an early identification of resistant cases, and a prompt treatment means, such as intrastromal antifungal therapy, to prevent permanent ocular damage