Intravitreal bevacizumab (Avastin) with PRP followed by Ahmed valve implantation appears to be effective in the management of NVG.

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The use of a combination of topical amphotericin B eye drops at a concentration of 0.2 mg/mL in dextrose 5% with subconjunctival injection of fluconazole 2 mg/mL had the advantage of a lower incidence of the complications of local use of amphotericin B and a broader spectrum of antifungal coverage. This study reports a relatively high success rate of healing of fungal keratitis, with a significant reduction of the potential side effects of the local use of antifungal agents.

PurposeTo evaluate the efficacy of combination therapy of a single intrastromal injection of amphotericin B and topical fluconazole in resistant cases of fungal keratitis, and also topical amphotericin B as monotherapy in terms of the duration of the recovery period and toxic drug effects.MethodsThis retrospective 2-year study reviewed 68 cases of unilateral fungal keratitis diagnosed by clinical features and positive laboratory culture results. Forty-one cases were resistant and did not respond to monotherapy with an antifungal agent. Thus, they were treated with a single intrastromal injection of amphotericin B in addition to topical fluconazole as combined antifungal therapy, representing group A. Twenty-seven cases were treated with topical amphotericin B as antifungal monotherapy, representing group B. Topical atropine 1% and different antibiotic eye drops were added to the antifungal agents in both groups. Follow-up of patient records was performed monitoring cure rate, duration of recovery period, and toxic drug effects such as pain, burning sensation, and corneal melting.ResultsThe results revealed that group A, treated with combination therapy, showed recovery of 34 cases (82.9%) with a mean duration of 24±6.42 days, significantly different from group B which showed recovery of 16 cases (59.3%) with a mean duration of 39.66±13.6 days. Group A also showed less manifestation of drug toxicity than group B.ConclusionCombined intrastromal injection of amphotericin B and topical fluconazole can provide a good modality in the treatment of resistant cases of fungal keratitis, exhibiting highly potent antifungal effects, shorter recovery period, and reduced corneal toxicity.