Intracameral amphotericin B: initial experience in severe keratomycosis.
OBJECTIVE
Fungal keratitis is a significant cause of ocular morbidity in India. The most commonly implicated fungi are Aspergillus spp. Patients often present with hypopyon, which usually contains fungal elements. The treatment is difficult owing to poor intraocular penetration of most available antifungal agents. This study evaluated the results of intracameral injection of amphotericin B in natamycin resistant cases of severe keratomycosis.


METHODS
Three patients of culture proven Aspergillus flavus corneal ulcer with hypopyon not responding to topical natamycin 5%, amphotericin B 0.15%, and oral itraconazole were administered intracameral amphotericin B. The first case received 7.5 microg in 0.1 mL followed by two subsequent injections of 10 microg in 0.1 mL each, the second case received two injections of 10 microg in 0.1 mL, and the third patient received a single dose of 10 microg in 0.1 mL. Culture of the aqueous sample also grew A. flavus in all three cases.


RESULTS
All three cases responded favorably, with the ulcer and hypopyon clearing completely. There was no clinical evidence of corneal or lenticular toxicity in any patient.


CONCLUSIONS
Intracameral amphotericin B may be a useful modality in the treatment of severe keratomycosis not responding to topical natamycin. It ensures adequate drug delivery into the anterior chamber and may be especially useful to avoid surgical intervention in the acute stage of the disease.
Kaushik
S
S
Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
Ram
J
J
Brar
G S
GS
Jain
A K
AK
Chakraborti
A
A
Gupta
A
A
D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use*; D000867:Anterior Chamber / Q000187:drug effects* / Q000382:microbiology; D000935:Antifungal Agents / Q000627:therapeutic use*; D001082:Aqueous Humor / Q000382:microbiology; D001228:Aspergillosis / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D001231:Aspergillus flavus / Q000302:isolation & purification*; D065306:Corneal Injuries; D003320:Corneal Ulcer / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D015821:Eye Infections, Fungal / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D005131:Eye Injuries / Q000382:microbiology; D006801:Humans; D007267:Injections; D008297:Male; D013492:Suppuration / Q000188:drug therapy / Q000382:microbiology
D000935:Antifungal Agents; D000666:Amphotericin B