Different Modalities of Antifungal Agents in the Treatment of Fungal Keratitis: A Retrospective Study

Abstract

Purpose: To evaluate the efficacy of different modalities of antifungal agents in the treatment, clinical features and therapeutic outcome of fungal keratitis Design: Retrospective observational case series. Methods:The study reviewed 251 eyes of 246 patients treated for moderate and severe fungal keratitis in the period from 2010 to 2015. The diagnosis of fungal keratitis based on the clinical characteristics features of fungal keratitis beside laboratory diagnosis. The antifungal drugs were determined according to the commercial availability at the time depending on the clinical features, also to some extent to the laboratory diagnosis. Ten different modalities of antifungal agents beside antibacterial agents and cycloplegic drugs were used.Results: Among the total treated 251 eyes, 194 eyes (77.29%) showed complete healed ulcers. But 121 eyes were treated by five groups of combined therapy of antifungal agents achieving healed ulcer in 97 eyes (80.16%). The study reported 10 groups of different modalities of antifungal agents. The highest curative rate was 88.46% in cases treated by combined therapy of corneal intrastromal injection of amphotericin B beside topical fluconazole with mean duration of healing (25.43 ± 4.09 days). The second rate was 84% in a combination of topical natamycine and subconjunctival injection of amphotericin B with mean duration of healing 27.95 ± 3.46 days. The shortest duration of healing was 24.83 ± 4.39 days in cases treated by a combination therapy of corneal intrastromal injection of voriconazole beside topical natamycine with curative rate 82.14%. Conclusions:The use of a combined therapy of antifungal agents achieved the best treatment modality in cases of fungal keratitis especially the combination of intrastromal injection of antifungal agents with topical one according to curative rate and duration of healed ulcers in cases of moderate and severe fungal keratitis.

Conjunctiva Necrosis Following Subconjunctival Amphotericin B Injection in Fungal Keratitis

“…This group was noted to achieve high curative rate just second to the group treated with a combination of intrastromal injection of AMB and topical fluconazole eye drops. There was no complication reported from subconjunctival AMB injection in this study [18]. Similarly, case series reported by Carrasco and Genesoni reviewed four cases of severe fungal keratitis treated with two to eight injections of subconjunctival conventional AMB as an adjunct to topical fluconazole eye drops [19].…”

Development of cyclodextrin-based pickering nanoemulsion containing amphotericin b for treatment of fungal keratitis

“…Various antifungal agents have been evaluated and including two major categories of antifungal agents: azole family and polyene family (16). Amphotericin B (AmB) has been used for more than 50 years and it remains the drug of choice for the management of severe systemic fungal infections (17,18).…”

“…Figure16 DSC thermograms of pure AmB (a), pure CD (b), pure HPCD (c), PM AmB/CD (d), PM AmB/HPCD (e), FD AmB/CD (f) and FD AmB/HPCD(f) …”