Excisional penetrating keratoplasty for fungal interface keratitis after endothelial keratoplasty: surgical timing and visual outcome

Fontana, Luigi; Caristia, Alice; Cornacchia, Alessandra; Russello, Giuseppe; Moramarco, Antonio

doi:10.1007/s10792-020-01576-1

Cited by 2 publications

(2 citation statements)

References 36 publications

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“…This underpins a need to improve the clinical efficacy for fungal keratitis through the scientific use of antibacterial drugs. [16][17] NAT eye drops are frequently used in the clinical treatment of fungal keratitis. This antifungal agent fights off a wide range of pathogenic filamentous fungi and yeast through direct contact with the corneal ulcer surface.…”

Section: Discussionmentioning

confidence: 99%

Clinical efficacy of cyclosporin and natamycin for fungal keratitis

Yang,

Cai,

Wei

et al. 2024

Pak J Med Sci

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Objectives: To investigate the clinical efficacy of cyclosporin (CYSP) and natamycin (NAT) as a combination therapy in patients with fungal keratitis. Methods: This is a retrospective study. A total of 64 patients (64 eyes) with fungal keratitis treated by Baoding No.1 Central Hospital between December 2018 and May 2022 according to their treatment methods were divided into a monotherapy (MT) group receiving NAT eye drops solely and a combination therapy (CT) group given CYSP eye drops in addition to the exact treatment provided for the MT group. The clinical responses, visual acuity changes, severity of eye symptoms, and adverse reactions were compared between the two groups. Results: At two and four weeks post-treatment, the CT group had an overall response rate (ORR) significantly higher than that of the MT group (P< 0.05, respectively); both groups showed improved visual acuity and eye symptoms compared with the pre-treatment condition, and these improvements were more pronounced in the CT group (P < 0.05, respectively). Compared with the MT group, the CT group experienced a significantly shorter duration of eye symptoms (P < 0.05). The adverse reaction rate(ARR) was 9.38% in the CT group and 6.25% in the MT group, and the difference was not significant (P > 0.05). Conclusion: Using CYSP and NAT as a combination therapy for fungal keratitis can substantially heighten the therapeutic effects, promote visual acuity recovery, and induce rapid remission of eye symptoms without increasing the risk of adverse reactions. doi: https://doi.org/10.12669/pjms.40.5.7777 How to cite this: Yang C, Cai J, Wei Q, Lian H, An L. Clinical efficacy of cyclosporin and natamycin for fungal keratitis. Pak J Med Sci. 2024;40(5):---------. doi: https://doi.org/10.12669/pjms.40.5.7777 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Section: Discussionmentioning

confidence: 99%

Clinical efficacy of cyclosporin and natamycin for fungal keratitis

Yang,

Cai,

Wei

et al. 2024

Pak J Med Sci

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“…Similarly, Tu et al [21] reported favorable outcomes in Alternaria keratitis and Jain et al [22] showed the success of intrastromal voriconazole in a fungal infection of the phacoemulsification site tunnel. Additionally, Fontana et al reported using intrastromal injections to treat fungal interface keratitis after endothelial keratoplasty [23]. The role of intrastromal voriconazole becomes particularly crucial in treating recalcitrant mycotic keratitis.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of the Combined Intrastromal Injection of Voriconazole and Amphotericin B in Recalcitrant Fungal Keratitis

Moramarco,

Grendele,

Iannetta

et al. 2024

Microorganisms

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This study aims to report the efficacy of a combined intrastromal injection in optimizing the outcome of severe mycotic keratitis. Herein, we report a case series of 20 consecutive patients with positive fungal cultures not responding to topical antifungal treatment. Patients received cycles of intrastromal injections of voriconazole (50 µg/0.1 mL) and amphotericin B (2.5 µg/0.1 mL); all patients continued their topical antifungal therapy. The organisms isolated were Fusarium (n = 5), Aspergillus (n = 4), Candida (n = 4), Rhodotorula (n = 2), Penicillium (n = 2), Alternaria (n = 1), Bipolaris (n = 1), and Curvularia (n = 1). The size of the infiltrate varied from 6.5 to 1.5 mm. At presentation, the best corrected visual acuity (BCVA, namely, the best visual acuity achieved with glasses, if needed) was less than 20/400 in all patients, improving to better than 20/400 in eleven patients. Seven patients required surgical intervention; four of them underwent penetrating keratoplasty (PK) à chaud one month after the first intrastromal injection. Patients who underwent surgery achieved a BCVA of 20/40 or better. Combined intrastromal injections before therapeutic penetrating keratoplasty (TPK) effectively reduced ulcer size and graft diameter, preventing infection recurrence. Our results highlight the efficacy of combined intrastromal injections in optimizing outcomes for severe mycotic keratitis undergoing TPK.

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Excisional penetrating keratoplasty for fungal interface keratitis after endothelial keratoplasty: surgical timing and visual outcome

Cited by 2 publications

References 36 publications

Clinical efficacy of cyclosporin and natamycin for fungal keratitis

Clinical efficacy of cyclosporin and natamycin for fungal keratitis

Efficacy of the Combined Intrastromal Injection of Voriconazole and Amphotericin B in Recalcitrant Fungal Keratitis

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