Topical and Oral Voriconazole in the Treatment of Fungal Keratitis

Bunya, Vatinee Y.; Hammersmith, K.M.; Rapuano, Christopher J.; Ayres, Brandon D.; Cohen, Elisabeth J.

doi:10.1016/j.ajo.2006.07.033

Cited by 114 publications

(76 citation statements)

References 7 publications

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“…Keratitis is usually treated with topical antifungal agents, and natamycin is the drug of choice (23). More recently, successful treatment with topical and oral voriconazole has been reported (13). Localized skin lesions in immunocompromised patients deserve special attention.…”

Section: Treatmentmentioning

confidence: 99%

Fusarium Infections in Immunocompromised Patients

2007

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SUMMARY Fusarium species cause a broad spectrum of infections in humans, including superficial, locally invasive, and disseminated infections. The clinical form of fusariosis depends largely on the immune status of the host and the portal of entry, with superficial and localized disease occurring mostly in immunocompetent patients and invasive and disseminated disease affecting immunocompromised patients. Risk factors for severe fusariosis include prolonged neutropenia and T-cell immunodeficiency, especially in hematopoietic stem cell transplant recipients with severe graft-versus-host disease. The most frequent presentation of disseminated fusariosis is a combination of characteristic cutaneous lesions and positive blood cultures, with or without lung or sinus involvement. The prognosis is poor and is determined largely by degree of immunosuppression and extent of infection, with virtually a 100% death rate among persistently neutropenic patients with disseminated disease. These infections may be clinically suspected on the basis of a constellation of clinical and laboratory findings, which should lead to prompt therapy. Treatment options include the lipid formulations of amphotericin B, voriconazole, and posaconazole. Prevention of fusarial infection among high-risk patients should be considered.

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Section: Treatmentmentioning

confidence: 99%

Fusarium Infections in Immunocompromised Patients

2007

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“…The treatment combines the systemic and the topical administration of voriconazole (6). More recently, voriconazole has successfully been used for the treatment of keratitis caused by a variety of fungi, most commonly, Aspergillus species, Fusarium species, and Candida species (2,8,9,11).…”

mentioning

confidence: 99%

Preparation and Stability of Voriconazole Eye Drop Solution

Dupuis

Tournier

Moal

et al. 2009

Antimicrob Agents Chemother

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The combined systemic and topical administration of voriconazole has successfully been used to treat keratomycosis. Because no voriconazole eye drop product is commercially available, we prepared a sterile eye drop solution (10 mg/ml). Voriconazole remains stable over 30 days, providing an eye drop solution suitable for use for the topical treatment of fungal keratitis.Voriconazole is a recent triazole antifungal agent that is highly effective against Aspergillus, Fusarium, and Candida species. Furthermore, voriconazole is one of the few drugs active against Scedosporium apiospermum (10). These fungi may cause severe keratomycosis, a rare but sight-threatening infection of the cornea (4).The conventional management of keratomycosis includes the local application, with or without systemic administration, of antifungal drugs. The use of voriconazole for the treatment of visually devastating disease due to Scedosporium apiospermum has been proposed (7,14). The treatment combines the systemic and the topical administration of voriconazole (6). More recently, voriconazole has successfully been used for the treatment of keratitis caused by a variety of fungi, most commonly, Aspergillus species, Fusarium species, and Candida species (2, 8, 9, 11).As is the case for many antimicrobial agents, no voriconazole eye drop solution is commercially available. Although several authors have reported on the potential of voriconazole for use for topical ophthalmic administration, none of them focused on the stability or the storage of voriconazole. This paper describes how we prepared a voriconazole ophthalmic solution. In addition, we performed a study in order to assess the stability of this solution over 1 month. Finally, the sterility of the preparation was evaluated.On the basis of information available in the literature (8, 9, 11), a 1% (10-mg/ml) voriconazole eye drop solution was prepared by using the branded product: voriconazole powder for solution for intravenous infusion (Vfend; Pfizer). Voriconazole powder (200 mg) was reconstituted with 19 ml of water for injections in order to obtain 20 ml of a 10-mg/ml voriconazole solution. Sterile filtration through a 0.20-m-pore-size filter was then performed. Finally, the voriconazole solution was packaged in a specific sterile vial for use as an eye drop solution. In order to keep the solution sterile, reconstitution was performed according to recommendations for aseptic preparation.In order to cure keratomycosis, antifungal eye drops must be administered over a long period (at least 6 weeks). Although the eye drop solution needs to be kept for several days after preparation for its use by a patient, its stability was unknown. Therefore, in order to assess the stability of the voriconazole eye drop solution, three batches of the formulation were stored for up to 30 days under different projected conditions suitable for its routine use. Under condition A, the solutions (n ϭ 6) were kept at room temperature (24 Ϯ 3°C) and were not protected from light (colorless type I glass via...

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“…Literatürde, 17 haftaya kadar topikal tedavi uygulanıp başarılı sonuçların elde edildiği hastalar bildirilmiştir. 11 Sonuç olarak, mantar keratitlerinde nadir gö-rülen türler izole edilebilmekte ve özellikle bitkisel travmalar önemli bir risk faktörü oluşturmaktadır. Bu tip hastalarda zamanında ve uygun tedavi büyük önem taşımaktadır.…”

Section: Discussionunclassified

A Case of Alternaria Alternata Keratitis

Özer¹,

Vatansever²,

Dinç³

et al. 2017

Turkiye Klinikleri J Ophthalmol

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ikrobiyal keratit; korneal lökom, korneal perforasyon, sekonder endoftalmi ve körlük gibi çok ağır komplikasyonlarla sonuçla-nabilen ciddi bir korneal enfeksiyon olup bakteriler, mantarlar veya parazitler nedeni ile ortaya çıkabilmektedir. Ülseratif keratit vakalarının %6-53'ünün mantarlara bağlı olduğu bildirilmiştir.1 Mantar keratitleri sıklıkla travma ile ilişkili olup, genellikle bitkisel materyallerle direkt travma sonucunda ortaya çıkmaktadır. Bu nedenle, daha çok bahçe işi ile uğraşanlarda ve çiftçilerde etken olarak saptanmaktadır. A An na ah ht ta ar r K Ke el li im me el le er r: : Alternaria alternata patotoksin TA; keratit; vorikonazol A AB BS ST TR RA AC CT T A seventy five years old male patient was admitted to clinic with redness, lacrimation and foreign body sensation in his right eye. He had a history of traumatic corneal injury with a plant leaf one month ago. In addition he had no systemic disease and medication history. Best corrected visual acuity was 5/10 in his right eye. On anterior segment examination in the right eye a raised edge lesion was observed at the center of cornea. Corneal scraping was taken from lesion area for microbiological study including fungal cultures. Microbiological examination of corneal scrapings demonstrated the presence of Alternaria alternata and the patient was treated with topical and systemic voriconazole. This is the second reported case of keratitis due to Alternaria spp in our country.

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Topical and Oral Voriconazole in the Treatment of Fungal Keratitis

Cited by 114 publications

References 7 publications

Fusarium Infections in Immunocompromised Patients

Fusarium Infections in Immunocompromised Patients

Preparation and Stability of Voriconazole Eye Drop Solution

A Case of Alternaria Alternata Keratitis

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