Medical interventions for fungal keratitis

FlorCruz, Nilo Vincent; Peczon, Ildefonso V

doi:10.1002/14651858.cd004241.pub2

Cited by 50 publications

(55 citation statements)

References 15 publications

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“…Although there is no gold standard for the treatment of fungal keratitis [1,6], the combination of systemic voriconazole and topical natamycin seems to represent one of the most commonly used antifungal treatment regimens. This correlates with results of the MUTT 1 trial from South India, which found topical natamycin 5 % to be superior to topical voriconazole 1 %, particulary for the treatment of Fusarium spp.…”

Section: Discussionmentioning

confidence: 99%

“…Fungal Keratitis: A Six-Year Review at a Tertiary Referral Centre Pilzkeratitiden: ein 6-Jahres-Rückblick an einem tertiären Hornhautzentrum Background Fungal keratitis is relatively uncommon in developed countries [1], but it appears to have become more frequent in recent years with increasing proportions of filamentous fungi and an increasing percentage of contact lens usage as a predisposing factor [2]. In an earlier Swiss multicentre review, we reported a distinct increase in contact lens-associated Fusarium keratitis that might have occurred even before the Fusarium outbreaks in 2005 and 2006, respectively [3].…”

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confidence: 99%

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Fungal Keratitis: A Six-Year Review at a Tertiary Referral Centre

Iselin

Baenninger

Schmittinger-Zirm

et al. 2017

Klin Monatsbl Augenheilkd

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This review reports the epidemiology, laboratory results, treatment regimens and costs of fungal keratitis at a tertiary referral center in Lucerne, Switzerland. Culture-proven fungal infections between January 2010 and December 2015 were reviewed retrospectively. Seventeen patients with a mean age of 52 years were identified. Contact lens wear was the most important risk factor (n = 11) (65 % of all cases), with filamentous fungi being identified as the most common fungus type (n = 10) (91 % of all cases of contact lens-associated fungal keratitis). All non-contact lens-associated fungal infections (n = 6) (35 % of all cases) were related to Six patients (35 %) were treated on an outpatient basis; 11 cases (65 %) required hospitalisation. Systemic voriconazole was the treatment regimen prescribed most often (n = 12) (71 %), followed by topical natamycin 5 % (n = 11) (65 %). Corneal crosslinking and penetrating keratoplasty were required in 4 cases each (24 %). One case ended up in enucleation (6 %). Average costs per case were EUR 15 952 for hospitalised patients if surgical intervention was required, and EUR 7415 if no intervention was performed. Average costs for outpatients were EUR 7079. In a majority of cases, visual acuity could be improved (n = 9) (53 %) or preserved (n = 2) (12 %). Despite the relatively low incidence of culture-proven keratitis (17 cases in 6 years), a clear pattern with regard to risk factors and fungus species was noted. In the absence of a gold standard for the treatment of fungal keratitis, the combination of systemic voriconazole and topical natamycin seems to be one of the most commonly used antifungal treatment regimens. The costs of outpatient versus inpatient non-surgical treatment were approximately the same.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Fungal Keratitis: A Six-Year Review at a Tertiary Referral Centre

Iselin

Baenninger

Schmittinger-Zirm

et al. 2017

Klin Monatsbl Augenheilkd

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“…(2,21) being the common pathogens. Current treatment for fungal keratitis is inadequate (8); thus, alternatives are needed.…”

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confidence: 99%

Penetration of Topically Administered 0.5-Percent Caspofungin Eye Drops into Human Aqueous Humor

Neoh

Leung

Misra

et al. 2011

Antimicrob Agents Chemother

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Ten participants attending elective anterior segment eye surgery received 0.5% caspofungin eye drops either 1 drop hourly for 4 h or 1 drop an hour before surgery. The eye drops were generally well tolerated. In the absence of inflammation or corneal abrasion, topical caspofungin does not achieve clinically relevant concentrations.Fungal keratitis is a potentially blinding condition, with Candida, Aspergillus, and Fusarium spp. (2, 21) being the common pathogens. Current treatment for fungal keratitis is inadequate (8); thus, alternatives are needed.Caspofungin has activity against a wide range of fungi, with MIC 90 values ranging from 60 to 2,000 ng/ml (15, 23). Caspofungin eye drops are effective for treatment of fungal keratitis in rabbits (11, 18) and have good penetration into animal eyes with inflammation or previous corneal abrasion (10, 23). Clinically, caspofungin is administered mostly intravenously (1,4,6,9,19,20) or intravitreally (24) for ocular mycosis. The successful use of topical caspofungin alone (13) or in combination with voriconazole (22) has been reported for two patients. However, the utility of topical caspofungin in fungal keratitis remains unknown, partly due to limited data on its penetration into human aqueous humor after topical administration. This study aimed to investigate the ocular penetration of 0.5% caspofungin eye drops into human aqueous humor.

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“…The Cochrane review8 in 2008 concluded that there was no evidence that the current available and investigational antifungal agents were effective. The review identified the need for large multicenter randomized trials.…”

Section: The Evidencementioning

confidence: 99%

Fungal keratitis

Tuli¹

2011

OPTH

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Clinical question:What is the most appropriate management of fungal keratitis?Results:Traditionally, topical Natamycin is the most commonly used medication for filamentous fungi while Amphotericin B is most commonly used for yeast. Voriconazole is rapidly becoming the drug of choice for all fungal keratitis because of its wide spectrum of coverage and increased penetration into the cornea.Implementation:Repeated debridement of the ulcer is recommended for the penetration of topical medications. While small, peripheral ulcers may be treated in the community, larger or central ulcers, especially if associated with signs suggestive of anterior chamber penetration should be referred to a tertiary center. Prolonged therapy for approximately four weeks is usually necessary.

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Medical interventions for fungal keratitis

Abstract: There is no evidence that the current available and investigational antifungal agents are effective. The review identified the need for large multicentre randomised trials.

Cited by 50 publications

References 15 publications

Fungal Keratitis: A Six-Year Review at a Tertiary Referral Centre

Fungal Keratitis: A Six-Year Review at a Tertiary Referral Centre

Penetration of Topically Administered 0.5-Percent Caspofungin Eye Drops into Human Aqueous Humor

Fungal keratitis

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