Oral voriconazole monotherapy for fungal keratitis: efficacy, safety, and factors associated with outcomes

Abstract

PurposeTo provide preliminary data on the efficacy and safety of oral voriconazole (VCZ) as a primary treatment for fungal keratitis (FK).MethodWe performed a retrospective histopathological analysis of data on 90 patients with FK at The First Affiliated Hospital of Guangxi Medical University between September 2018 and February 2022. We recorded three outcomes: corneal epithelial healing, visual acuity (VA) improvement, and corneal perforation. Independent predictors were identified using univariate analysis, and multivariate logistic regression analysis was used to identify independent predictive factors associated with the three outcomes. The area under the curve was used to evaluate the predictive value of these factors.ResultsNinety patients were treated with VCZ tablets as the only antifungal drug. Overall, 71.1% (n = 64) of the patients had extreme corneal epithelial healing, 56.7% (n = 51) showed an improvement in VA, and 14.4% (n = 13) developed perforation during treatment. Non-cured patients were more likely to have large ulcers (≥5 × 5 mm2) and hypopyon.ConclusionThe results indicated that oral VCZ monotherapy was successful in the patients with FK in our study. Patients with ulcers larger than 5 × 5 mm2 and hypopyon were less likely to respond to this treatment.

Recent Advances in Diagnosis and Treatment Approaches in Fungal Keratitis: A Narrative Review

“…Fungal keratitis usually responds over an extended period of weeks to antifungal therapy, and signs of improvement in an ulcer include a decrease in pain and also in the size of the infiltrate, disappearance of the satellite lesions, rounding out of the feathery margins of the corneal ulcer, and hyperplastic masses in the region of healing fungal lesions. A few advantages and disadvantages to known antifungal therapies are provided in Table 2 [ 2 , 62 , 63 , 64 ].…”

Treatment of resistant paecilomyces lilacinus keratitis with topical voriconazole and oral itraconazole: A rare case report from somalia

“…Currently, the mainstay of treatment remains antifungal drug therapy. Furthermore, the wide range of Voriconazole has been shown, making it the most promising treatment for FK at this time 9 . Paecilomyces lilacinus is the Paecilomyces species that is most commonly found to be the dominant species.…”

Fungal Keratitis: Diagnosis, Management, and Recent Advances

“…61 However, other studies have claimed beneficial effects of oral voriconazole alone or in combination with topical antifungal treatment. 62,63 Systemic Anti-Fungal Agents Include…”