Advances in the Management of Keratomycosis and Acanthamoeba Keratitis

O’Day, Denis M.; Head, W. Steven

doi:10.1097/00003226-200009000-00013

Cited by 51 publications

(41 citation statements)

References 82 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Unfortunately, side effects limited the intravenous use of this drug in many cases, as compared to the rather marginal intravitreal levels achieved after intravenous administration. However, it was O'Day and Head [1] who later demonstrated that the triazole agent fluconazole was able to achieve significant levels of this drug in the vitreous after systemic administration. This newer antifungal agent was therefore the first showing intraocular penetration due to lower protein binding and improved water solubility.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Aqueous Humor Concentrations of Topically Administered Caspofungin in Rabbits

et al. 2008

View full text Add to dashboard Cite

Background: The echinocandin caspofungin (CAS) is a novel antifungal drug with fungicidal in vitro activity against all Candida spp., which are the most frequent cause of fungal keratitis. Penetration of CAS through the cornea into the aqueous humor after topical administration was investigated. Methods: A CAS solution with a concentration of 7 mg/ml was applied onto each rabbit’s cornea. Drug application after corneal epithelium abrasion was processed in different time intervals: single application with aqueous humor sampling after 1 and 2 h. In addition, after continuous application of CAS every 30 min, aqueous humor concentrations of CAS after 1, 2 and 5 h were analyzed by liquid-chromatography tandem mass spectrometry. Results: Topical administration of CAS without corneal epithelium abrasion resulted in no detectable amounts of the drug in the aqueous humor. However, with corneal abrasion, after a single application, levels of 2.16 ± 1.57 μg/ml (n = 6) were reached after 1 h and then decreased to 1.76 ± 0.88 μg/ml (n = 2) after 2 h. After serial application every 30 min, the following intracameral levels of CAS were detected: after 1 h, 2.11 ± 1.09 μg/ml (n = 6); after 2 h, 4.94 ± 1.80 μg/ml (n = 5), and after 5 h, 3.45 ± 2.11 μg/ml (n = 6). Conclusion: In the aqueous humor, therapeutic drug levels can be reached that cover the MICs of most fungi after epithelial abrasion. To achieve a sustained high level of CAS as an effective antifungal therapy for corneal keratitis, CAS should be administered topically every 30 min after removal of the corneal epithelium.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Keratitis is the most frequent presentation [1] , but the orbit, lids and lacrimal apparatus, conjunctiva, sclera and intraocular structures may also be involved. Comprehensive reviews of fungal diseases have been published by Behrens-Baumann [2] and Klotz et al [3] .…”

Section: Introductionmentioning

confidence: 99%

Aqueous Humor Concentrations of Topically Administered Caspofungin in Rabbits

et al. 2008

View full text Add to dashboard Cite

show abstract

“…Corticosteroids suppress the activity of the macrophage, which is essential in scavenging and destroying the amoeba [6]. Thus, in general, it is recommended to delay and limit steroid use as much as possible, utilizing it in combination with antiamoebic agents and only in those patients with severe pain, scleritis, or severe anterior-chamber inflammation [38,42,43]. In patients with severe scleral involvement, systemic immunosuppression may be necessary and has been described using oral steroids, cyclosporine, and azathioprine [44].…”

Section: Medical Treatmentmentioning

confidence: 99%

Diagnosis and management of Acanthamoeba keratitis

Hammersmith¹

2006

Current Opinion in Ophthalmology

133

103

View full text Add to dashboard Cite

Acanthamoeba keratitis continues to be a difficult infection to diagnose and manage. The frequency of these infections may be on the rise, most commonly associated with frequent replacement soft contact lenses. The best chance for a good outcome is based on early diagnosis, so it is important for ophthalmologists consider it in patients, especially in the contact lens wearer with suspected herpes simplex keratitis.

show abstract

“…6 However, polyene antibiotics are generally toxic to the cornea, 7,8 and although no toxicity of azole derivatives has been reported, azole-resistant fungi are gradually emerging. 7,9 Recently, a new class of antifungal agent, candin derivatives, has become available.…”

mentioning

confidence: 99%