Comparative Evaluation of Topical versus Intrastromal Voriconazole as an Adjunct to Natamycin in Recalcitrant Fungal Keratitis

Sharma, Namrata; Chacko, Jacob; Velpandian, Thirumurthy; Titiyal, Jeewan S; Sinha, Rajesh; Satpathy, Gita; Tandon, Radhika; Vajpayee, Rasik B

doi:10.1016/j.ophtha.2012.09.023

Cited by 95 publications

(80 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Sharma et al 25 found no significant benefit of adding intrastromal voriconazole to topical natamycin for treating recalcitrant fungal keratitis in 40 eyes randomly assigned to receive topical or intrastromal voriconazole in addition to natamycin. However, we injected intrastromal voriconazole in eyes that did not respond to combination of topical voriconazole and natamycin.…”

Section: Discussionmentioning

confidence: 99%

Intrastromal voriconazole for deep recalcitrant fungal keratitis: a case series

et al. 2014

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Intrastromal voriconazole for deep recalcitrant fungal keratitis: a case series

et al. 2014

View full text Add to dashboard Cite

show abstract

“…No difference was found between intrastromal versus topical treatment. 2 Finally a review of 40 case-reports showed that voriconazole is safe and effective against the major ocular fungal infections. 43 It is to be noted, however, that the efficacy of voriconazole as a single agent or initial treatment incurs a significant medical failure risk.…”

Section: Voriconazolementioning

confidence: 99%

Current Thoughts in Fungal Keratitis: Diagnosis and Treatment

Ansari

Miller

Galor

2013

Curr Fungal Infect Rep

244

219

View full text Add to dashboard Cite

Fungal keratitis remains a challenging and often elusive diagnosis in geographic regions where it is endemic. Marred by delays in diagnosis, the sequelae of corneal fungal infections, though preventable, can be irreversible. Recent studies and advances in the arena have broadened the approach and treatment to mycotic keratitis. This review will discuss current diagnostic modalities of fungal keratitis and will particularly focus on treatment regimens. It will also explore future therapeutic models and critique the potential benefit of each.

show abstract

“…In the study of Namrata Sharma et al, 8,9 the best-corrected visual acuity of < 20/1200 in all patients at the time of presentation, improved to better than 20/400(6/60) in 83.3% eyes. In the study of Namperumalsamy et al, 10 with a baseline BSCVA of 20/40 (6/12) to 20/400 (6/60) showed a trend toward a 2-line improvement in visual acuity with voriconazole.…”

Section: Discussionmentioning

confidence: 88%

“…In the study of Gaurav Prakash et al 7 , a complete resolution of all the ulcers was seen within 3 wks. In the study of Namrata Sharma et al 8,9 resolution time was 4-6 wks. In 83.3% cases.…”

Section: Discussionmentioning

confidence: 99%

Clinical Evaluation of Intrastromal Voriconazole in Recalcitrant Fungal Keratitis a Prospective Study at Sarojini Devi Eye Hospital, Hyderabad

K¹,

Ravinder²,

B³

et al. 2015

jemds

View full text Add to dashboard Cite

Patients of Fungal Keratitis not responding to routine topical and systemic antifungal therapy in 7 to 14 days, which were diagnosed as Recalcitrant fungal keratitis were given 5µgms/0.1ml of voriconazole intrastroml injections around the fungal infiltrates in a grid pattern. Details of patients age and sex, type of causative fungal and traumatic agents, size of corneal ulcer, presence of Hypopyon or not, and time taken for hypopyon absorption, and clinical improvement and resolution of the ulcer and visual acuity were noted. RESULTS: This study group of 30 patients diagnosed as Recalcitrant fungal keratitis showed Causative Fungi as Fusarium in 19(63.0%), Aspergillus in 11(37.0%). Causative Traumatic Agents were vegetative matter in 19 (63.3%), other agents in 8(26.7%) and not known in 3(10.0). 17(56.7%) were Males with 13(43.3%) Females. Age wise distribution was 3(10.0%) in>10-20yrs, 11(36.7%) in 20-40 yrs, 15(50.0%) in 40-60 yrs, and 1(3.3%) in >60 yrs. The size of the ulcer showed <1/2 of the cornea in 21(70.0%) and >1/2 of the cornea in 9(30.0%). 19 (63.3%) were with hypopyon and 11(36.7%) without hypopyon. After Intrastromal Voriconazole, the absorption of Hypopyon in 12 (63.2%) was in 2to 4 wks. and in 2(10.5%) in > 4 wks. Clinical improvement of the Fungal Corneal Ulcer was seen in no case (0.0%) in <1 st wk., in 24(80.0%) in 2 to 4wks and in 2(6.7%) in > 4 wks. Time (wks.) of healing of the Fungal Corneal Ulcer was in 4-6wks in 21 (70.0%) and in >6wks in 5(16.7%). Visual Acuity was <3/60 in 2(7.7%), 3/60-<6/60 in 10(33.3%), 6/60-<6/18 in 9(30.0%) and 6/18-6/9 in 5(16.7%). CONCLUSION: Common causes of fungal keratitis in Recalcitrant Fungal keratitis were Fusarium in 15(50.0%), Aspergillus in 12(40.0%) and Candida in 3(10.0). Intrastromal Voriconazole has a therapeutic role in resolving recalcitrant fungal keratitis not responding to routine antifungal therapy within 4-6 wks.

show abstract

Comparative Evaluation of Topical versus Intrastromal Voriconazole as an Adjunct to Natamycin in Recalcitrant Fungal Keratitis

Cited by 95 publications

References 22 publications

Intrastromal voriconazole for deep recalcitrant fungal keratitis: a case series

Intrastromal voriconazole for deep recalcitrant fungal keratitis: a case series

Current Thoughts in Fungal Keratitis: Diagnosis and Treatment

Clinical Evaluation of Intrastromal Voriconazole in Recalcitrant Fungal Keratitis a Prospective Study at Sarojini Devi Eye Hospital, Hyderabad

Contact Info

Product

Resources

About