Intracameral Amphotericin B Injection in the Management of Deep Keratomycosis

Kuriakose, Thomas; Kothari, Mihir; Paul, Padma; Jacob, Paul; Thomas, Ravi

doi:10.1097/00003226-200210000-00004

Cited by 65 publications

(57 citation statements)

References 16 publications

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“…In one case healing occurred with formation of corneal opacity while the other two required therapeutic keratoplasty. Kuriakose et al [7] reported complete healing in three out of four patients with intracameral amphotericin B. Hence, intracameral amphotericin B has some role in management of keratomycosis.…”

Section: Discussionmentioning

confidence: 98%

Medical and Surgical Management of Keratomycosis

Singh

Kalra

et al. 2008

Medical Journal Armed Forces India

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Original ArticleIntroduction I nfective keratitis is an important cause of corneal blindness and fungal keratitis is a major subgroup accounting for around 30% of all cases. Fungal keratitis remains a diagnostic and therapeutic challenge to the ophthalmologist and is associated with significant ocular morbidity. Management remains a problem due to poor ocular penetration of antifungal drugs. We conducted a study to assess the efficacy of various drugs in keratomycosis, efficacy of surgical management and the final visual outcomes after combined medical and surgical management. Materials and MethodsTwenty five consecutive cases of keratomycosis reporting to our department were studied. Diagnosis was based on history of ocular trauma especially with organic matter, clinical signs more than symptoms, ulcers with feathery margins, satellite lesions and presence of convex hypopyon. Corneal scrapings were taken and stained with Grams, potassium hydroxide (KOH), lactophenol blue and inoculated onto blood agar and Sabouraud's medium. Only those cases were included whose laboratory samples were positive for fungal elements or fungal growth. Thereafter, antifungal drugs were instituted and patients were followed up for a period of minimum three months after recovery from infection. However, those managed surgically were followed up for one year.The corneal ulcers were classified into mild, moderate or severe depending upon degree of corneal involvement. Mild ulcers: <1/3rd superficial stromal involvement. Moderate ulcers: 1/3rd-2/3rd stromal involvement. Severe ulcers:>2/3rd stromal involvement, ulcer near limbus, impending perforation or perforated ulcers.Medical management included topical 5% natamycin drops, 1% itraconazole drops or 0.15% amphotericin B drops. The drops were instilled at 15 minute intervals for the first two hours, then hourly round the clock and then tapered off once clinical improvement occurred. Efficacy of medical management was assessed biomicroscopically by evaluating edge of infiltrate, density of suppuration, cellular infiltrate and oedema of surrounding stroma, and hypopyonThe cases with poor response to medical management, were taken up for surgery . Wherever possible anterior chamber paracentesis was done and 10 μgm of reconstituted amphotericin B in 0.1ml of 5% dextrose was injected into the anterior chamber. In patients with impending perforation or perforated cornea, therapeutic keratoplasty was done using fresh or preserved donor cornea and where required this was followed in turn by optical penetrating keratoplasty. In all cases donor corneal button with 0.5mm oversize was used. Postoperatively patients were kept on oral and topical antifungals with other supportive measures. ResultsOut of 25 patients studied, 19 (76%) were males and six (24%) were females. Eighteen (72%) belonged to a rural background and seven (28%) to an urban background. Twenty

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Section: Discussionmentioning

confidence: 98%

Medical and Surgical Management of Keratomycosis

Singh

Kalra

et al. 2008

Medical Journal Armed Forces India

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“…(6,8) Generally, prolonged and intensive topical and systemic antifungal therapy is required to eradicate the fungal infections. Contemporary antifungal drugs in the treatment of mycotic keratitis are less effective than contemporary antibacterial drugs in the treatment of bacterial keratitis.…”

Section: Discussionmentioning

confidence: 99%

“…Intracorneal and intracameral injections of amphotericin B. (6,7,8,9) and Intracameral Amphotericin-B. (6,8) were tried in fungal keratitis.…”

Section: Introductionmentioning

confidence: 99%

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Intracameral and Intracorneal Voriconazole in Deep Keratomycosis With Endothelial Plaque

Killani¹,

Atti²,

Gupta³

et al. 2015

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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.

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“…Given the small sample size and correspondingly limited statistical power, the authors recommended larger randomized clinical trials to help resolve the roles of both intracameral antifungal administration and anterior chamber irrigation in the management of severe keratomycosis. [25][26][27][28][29] Together, these studies highlight both the challenges of treating infectious keratitis and the promise and importance of novel therapeutic approaches. For now, intensive, topical antimicrobial therapy remains the mainstay of treatment.…”

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confidence: 99%