Successful topical application of a new antifungal agent, micafungin, in the treatment of refractory fungal corneal ulcers: report of three cases and literature review.
OBJECTIVE
To report the efficacy of topical application of a new antifungal agent, micafungin (MCFG), in the treatment of yeast-related corneal ulcers.


METHODS
Noncomparative interventional case reports.


METHODS
Three patients with yeast-related corneal ulcer after keratoplasty recalcitrant to conventional antifungal treatment for 4 weeks were recruited in this study.


METHODS
Topical 0.1% antifungal MCFG eye drops were applied in 3 patients with yeast-related corneal ulcer every hour while awake until epithelialization. After epithelialization, the frequency of eye drops was reduced to 5 times a day. MCFG eye drops were discontinued 1 month after the disappearance of stromal infiltration in each case. The patients underwent best corrected visual acuity (BCVA) measurements, slit-lamp examination, fluorescein-dye staining, and anterior segment photography. Corneal scrapings and cultures of surgical materials were also performed.


METHODS
Changes in ulcer size, stromal infiltration, fluorescein dye staining, and BCVA were looked for.


RESULTS
All corneal ulcers epithelialized within 14 days after commencement of application of 0.1% MCFG eye drops. Yeasts were detected from corneal smears in all eyes. Two cases revealed positive culture isolates for Candida albicans and Candida parapsilosis. No recurrence of fungal keratitis was observed in any of the cases throughout the follow-up periods.


CONCLUSIONS
Topical 0.1% MCFG eye drops seem to be an effective and a promising option in the treatment of refractory yeast-related corneal ulcers.
Matsumoto
Yukihiro
Y
Department of Ophthalmology, Tokyo Dental College, Chiba, Japan. ymatsumoto@pop11.odn.ne.jp
Dogru
Murat
M
Goto
Eiki
E
Fujishima
Hiroshi
H
Tsubota
Kazuo
K
D000287:Administration, Topical; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D002176:Candida albicans / Q000302:isolation & purification; D002177:Candidiasis / Q000188:drug therapy* / Q000382:microbiology; D003320:Corneal Ulcer / Q000188:drug therapy* / Q000382:microbiology; D054714:Echinocandins; D015821:Eye Infections, Fungal / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006801:Humans; D015948:Keratoplasty, Penetrating; D055666:Lipopeptides; D008074:Lipoproteins / Q000627:therapeutic use*; D000077551:Micafungin; D008875:Middle Aged; D009883:Ophthalmic Solutions / Q000627:therapeutic use; D010456:Peptides, Cyclic / Q000627:therapeutic use*; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000382:microbiology; D016896:Treatment Outcome
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D008074:Lipoproteins; D009883:Ophthalmic Solutions; D010456:Peptides, Cyclic; D000077551:Micafungin