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2005 OMIG, Abstract 10

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Topical Voriconazole For The Treatment of Fungal Keratitis

Vatinee Y. Bunya, MD, Kristin M. Hammersmith MD, Elisabeth J. Cohen, MD, & Christopher J. Rapuano, MD Cornea Service, Wills Eye Hospital

Purpose: To assess the efficacy and safety of topical voriconazole as an alternative therapy for fungal keratitis refractory to traditional antifungal treatment.

Methods: A retrospective case series, which includes 9 eyes of 9 patients (mean age 59, age range 22-82) who had failed to respond to topical natamycin or amphotericin, with or without oral antifungal therapy (itraconazole, ketoconazole, or fluconazole). All patients were initially treated with voriconazole drops every hour around the clock which was gradually tapered depending on the clinical response to therapy. Seven of the nine patients were also treated with oral voriconazole (2 patients were continued on oral itraconazole).

Results: Eight eyes showed a clinical response to the topical voriconazole. The culture results were as follows: Candida albicans (3), Fusarium (3), Alternaria (1), Scopulanopsis (1), and Scedosporium (1). One eye (Fusarium) required a cornea! transplant for a perforated ulcer. One patient had to discontinue treatment due to severe burning after administration of the drops. No systemic side effects were observed. Final visual acuity depended on the location of the remaining scar, as well as the presence of concomitant disease such as glaucoma.

Conclusions: Topical voriconazole may be a useful and safe treatment of severe fungal keratitis that is unresponsive to other antifungal therapies. Future larger studies are necessary to further determine the efficacy of this therapy compared to other antifungal treatments.


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