Successful Topical Application of Caspofungin in the Treatment of Fungal Keratitis Refractory to Voriconazole

Abstract

RESEARCH LETTERSSuccessful Topical Application of Caspofungin in the Treatment of Fungal Keratitis Refractory to Voriconazole F ungal keratitis is an important ophthalmic problem because it leads to corneal blindness and sometimes to loss of the eye. 1,2 There is no agreed protocol for the treatment of suspected fungal keratitis. Topical and oral voriconazole have now been reported to be effective. 3 However, some cases do not respond to this treatment. New antifungal agents such as caspofungin acetate, 0.5%, are promising alternatives.Report of a Case. A 60-year-old woman with a history of penetrating keratoplasty in her right eye due to corneal herpetic infection 1 year earlier was admitted be-

Fungal, Mycobacterial, and Nocardia infections and the eye: an update

“…15 Some of the new molecules investigated in recent past include azoles (voriconazole and posaconazole) and eccinocanidines (caspofungin and micafungin). 16,17 While the pharmacological properties, in-vitro susceptibility, as well as the anecdotal reports suggest superiority of voriconazole over other antifungal agents, 16 a randomized clinical trail in South India comparing natamycin with voriconazole in treatment of mycotic keratitis did not find any difference in the scar size, visual acuity, and perforation rate. 18 Therefore, more clinical trials are required to provide rigorous evidence basis to guide using these molecules.…”

Update on Management of Fungal Keratitis

“…Echinocandins, include caspofungin, micafungin, and anidulafungin. Recently, one case reported by Hurtado-Sarrio et al demonstrated successful treatment of Candida albican keratitis refractory to voriconazole using topical caspofungin [85]. Tu EY reported 3 cases of Alternaria keratitis refractory to voriconazole and natamycin and successful treatment by topical caspofungin and topical fluconazole [86,87].…”

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

“…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.…”

“…Caspofungin eye drops (0.5%) (11,13,22) were prepared aseptically; 10.5 ml of water for injection was added to a 50-mg vial of caspofungin. All eye drops were freshly prepared and used within 24 h (7).…”