Fungal keratitis, one of the major causes of ophthalmic mycosis is second only to cataract as the most common cause of blindness worldwide. OBJECTIVEThe aim was to study the intracorneal and intracameral Voriconazole in deep keratomycosis with endothelial plaque. MATERIALS AND METHODSThis was a study in the Cornea Clinic of Sarojini Devi Eye Hospital and Regional Institute of Ophthalmology, a Tertiary Care Teaching Hospital of Osmania Medical College (Govt.), Hyderabad, over a period from September 2012 to August 2014. The study group included 30 patients who were diagnosed clinically and microbiologically (+ve smear and culture) as fungal corneal ulcers with deep stromal infiltrates and endothelial plaque not responding to routine antifungal drugs and given voriconazole intracorneally and intracamerally.Data of patient's age and sex and history of corneal trauma with type of the agents were noted. The time of healing of the ulcer with the scar formation after intracorneal and intracameral voriconazole was noted and the visual acuity was recorded after the healing of the corneal ulcer. RESULTSThirty eyes of 30 patients with deep keratomycosis with endothelial plaque were evaluated; 19(63.3%) were Males and 11(36.7%) were Females. ; 12 (40.0%) in 6-8 wks., 5(16.7%) in 8-10 wks., and 4(13.3%) in 10-12 wks.; 25(83.3%) which were healed by corneal scarring were given 1 (One) intracorneal and intracameral injection of Voriconazole. The 5(16.7%) did not respond to 2 (Two) intracorneal and intracameral voriconazole injections, progressed to corneal perforations and were treated by Therapeutic Penetrating keratoplasty. Visual acuity was <3/60 in 18(60.0%) and 3/60 to <6/60 in 12(40.0%), and <3/60 in 3(10.0%), 3/60-<6/60 in 13(43.3%) and 6/60-<6/18 in 9(30.0%) before and after the intracorneal and intracameral voriconazole respectively. CONCLUSIONSTargeted delivery of Intracorneal and Intracameral Voriconazole was effective with a better visual outcome and a significant reduction in healing time in deep keratomycosis with endothelial plaque not responding to routine antifungal therapy.

BACKGROUNDEndothelial cell loss during cataract surgery leads to corneal decompensation and visual loss.

INTRODUCTIONThere are 180 million people in the world today with severe visual impairment, which is a tragic and pathetic situation both socially and economically and 80% of visual impairment is avoidable. 1-3 Corneal blindness is a major health problem worldwide. Corneal blindness is most commonly caused by the trauma or infection. Corneal laceration injuries are more common in male than females and typically occur in younger age group. The most frequent causes are assault, domestic, occupational and sports. Corneal astigmatism after injuries can prevent a good visual outcome. It arises from many causes like wound factors of length, location and angulations, and suturing factors of the type of suture ABSTRACT Background: Corneal lacerations are the common cause of astigmatism that can prevent a good visual outcome. This was to evaluate Astigmatism in relation to the Length and Site of Corneal Lacerations. Methods: This was a study in the Cornea clinic, Sarojini Devi Eye Hospital and Regional Institute of Ophthalmology, Osmania Medical College, Hyderabad over a period from August 2012 to April 2014. The study group was 25 Patients of corneal lacerations. The data of age and sex, the length of corneal lacerations in terms of corneal diameter of <1/3rd and >1/3rd and the site of the laceration in the cornea either central or peripheral was noted. All the corneal lacerations were sutured with interrupted 10-0 mono filament nylon. Suture removal was done over a period of 6 -12 weeks following surgery. Astigmatism (Diopters) was estimated by Keratometer after sutures removal. Results: Our study age distribution was 11(44.0%) in >10 -20 yrs, 11 (44.0%) in 21 -30 yrs and 3(12.0%) in 31 -40 yrs. Sex distribution was 17(68.0%) of males and 8(32.0%) of females. The length of Corneal laceration in terms of corneal diameter was < 1/3rd in 4(16.0%) and >1/3rd in 21(84.0%). The site of Laceration in the cornea was peripheral in 6(24.0%) and central in 19(76.0%). The Astigmatism in relation to Length and Site of Corneal Laceration showed < 2.0 D in 3(12.0%), 2 -4.0 D in 11(44.0%), 4-6.0 D in 4(16.0%), > 6.0D in 4(16.0%) and irregular astigmatism in 3(12.0%). The astigmatism in peripheral corneal lacerations of < 1/3rd and > 1/3rd of corneal diameter was < 2.0 D in 12.0% and 2-4.0 D in 12.0% respectively. The Astigmatism in central corneal lacerations of <1/3rd and >1/3rd of corneal diameter was 2-4.0D in 4.0% and 2-4.0D in 28.0%, 4-6.0D in 16.0%, >6.0D in 16.0% and irregular Astigmatism in 12.0% respectively. Time of sutures removal was 80.0% at 6-8 wks, 12.0% at 8-10 wks and 8.0% at 10 -12 wks. Conclusions: The corneal astigmatism depends upon the length and site of corneal laceration. Severity of astigmatism was directly proportion to the length of corneal laceration. The wound was nearer to the centre of the cornea, the greater was the astigmatism.