title: Management of tunnel fungal infection with voriconazole.
abstract: A 59-year-old woman presented 1 month after cataract surgery in the right eye with a stromal infiltrate at the site of the cataract surgery wound. The visual acuity was perception of light with accurate projection. Corneal scraping of the infiltrate revealed septate hyphae. There was no response to 6 weeks of therapy with topical fortified antibiotic agents and topical antifungal therapy in the form of natamycin 5%, amphotericin B 0.15%, and intracameral amphotericin B. The patient was started on oral voriconazole 200 mg twice daily and topical voriconazole 1% every hour, and resolution of the ulcer was noted within 3 days. At the 4-month follow-up, a visual acuity of 20/60 was achieved, with the formation of a vascularized corneal opacity superiorly. This case illustrates that topical and oral voriconazole may be used in the treatment of recalcitrant cases of fungal tunnel infections not responding to conventional antifungal therapy.
authors.affiliation: Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Vishal
authors.initials: V
authors.lastname: Jhanji
authors.forename: Namrata
authors.initials: N
authors.lastname: Sharma
authors.forename: Rashim
authors.initials: R
authors.lastname: Mannan
authors.forename: Jeewan S
authors.initials: JS
authors.lastname: Titiyal
authors.forename: Rasik B
authors.initials: RB
authors.lastname: Vajpayee
mesh_terms: D000284:Administration, Oral; D000287:Administration, Topical; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D002387:Cataract Extraction; D003320:Corneal Ulcer / Q000188:drug therapy* / Q000382:microbiology; D015821:Eye Infections, Fungal / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D005670:Fusarium / Q000302:isolation & purification*; D006801:Humans; D008866:Microsurgery; D009181:Mycoses / Q000188:drug therapy* / Q000382:microbiology; D011743:Pyrimidines / Q000627:therapeutic use*; D013530:Surgical Wound Infection / Q000188:drug therapy* / Q000382:microbiology; D014230:Triazoles / Q000627:therapeutic use*; D014792:Visual Acuity; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole