Intrastromal injection of antibiotic agent in the management of recalcitrant bacterial keratitis

Abstract

Intrastromal injection is a novel method of delivering an antibiotic agent directly to the site of keratitis. Although intrastromal antifungal agents have been used to manage refractory fungal keratitis, the experience with intrastromal antibiotic agents for bacterial keratitis is more limited. We report a case of refractory bacterial keratitis treated with an intrastromal antibiotic agent and discuss the potential for the clinical use of this modality.

Corneal stromal abscessation in two horses treated with intracorneal and subconjunctival injection of 1% voriconazole solution

“…To overcome these problems, modalities of targeted drug delivery have been evaluated in humans and horses . In humans, Prakash et al .…”

“…Due to the poor response to medical therapy and the potential for loss of vision from the complications of severe uveitis, an intracorneal and subconjunctival voriconazole injection was opted for, instead in expectation of, achieving higher intracorneal concentration of this antifungal drug. This decision was supported by reports of successful outcomes of deep recalcitrant fungal keratitis using intracorneal voriconazole injection in both humans and horses . Moreover, this procedure was considered because it could offer shortened anesthesia times and be performed inexpensively compared with surgical excision of the abscess and replacement with a donor corneal graft given the financial constraints of the client.…”

“…This decision was supported by reports of successful outcomes of deep recalcitrant fungal keratitis using intracorneal voriconazole injection in both humans and horses. 17,[19][20][21][23][24][25] Moreover, this procedure was considered because it could offer shortened anesthesia times and be performed inexpensively compared with surgical excision of the abscess and replacement with a donor corneal graft given the financial constraints of the client. The only other option the client would consider for this eye was enucleation.…”

“…To address these problems, targeted delivery of voriconazole by intracorneal injection technique has been recently reported for the treatment of recalcitrant DSA, and the procedure resulted in early and complete resolution of the DSA in both humans and horses …”

“…[7][8][9][10][11]14,15 To address these problems, targeted delivery of voriconazole by intracorneal injection technique has been recently reported for the treatment of recalcitrant DSA, and the procedure resulted in early and complete resolution of the DSA in both humans and horses. [16][17][18][19][20][21][22] This case report details the clinical presentation, diagnosis, medical management, and the intracorneal and subconjunctival voriconazole injection technique utilized for the therapy of DSA in horses.…”