title: Evaluation of intrastromal injection of voriconazole as a therapeutic adjunctive for the management of deep recalcitrant fungal keratitis.
abstract: OBJECTIVE
  To evaluate the role of intrastromal injection of voriconazole in the management of deep recalcitrant fungal keratitis.
  
  
  METHODS
  Interventional case series.
  
  
  METHODS
  
  
  
  METHODS
  Cornea services at a tertiary care teaching hospital.
  
  
  METHODS
  Three eyes of three patients with deep stromal recalcitrant fungal keratitis not responding to topical antifungal medications. Intervention Procedure: Voriconazole 50 micrograms/0.1 ml was injected circumferentially around the fungal abscess in the corneal stroma as an adjunctive to the topical antifungal therapy.
  
  
  METHODS
  Main outcome measure was a reduction in size of the abscess and resolution of the infection.
  
  
  RESULTS
  Before the intracorneal injection, all three eyes had gradually worsening lesions on topical medications. After the intervention, a faster reduction in the size of corneal infiltration was documented and a complete resolution of the ulcers was seen within three weeks in all cases.
  
  
  CONCLUSIONS
  Targeted delivery of voriconazole by intracorneal injection may be a safe and effective way to treat cases of deep-seated recalcitrant fungal keratitis responding poorly to conventional treatment modalities.
authors.affiliation: Cornea and Refractive Surgery Services, Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Prakash
authors.forename: Namrata
authors.initials: N
authors.lastname: Sharma
authors.forename: Manik
authors.initials: M
authors.lastname: Goel
authors.forename: Jeewan S
authors.initials: JS
authors.lastname: Titiyal
authors.forename: Rasik B
authors.initials: RB
authors.lastname: Vajpayee
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage*; D001228:Aspergillosis / Q000188:drug therapy* / Q000382:microbiology; D001230:Aspergillus / Q000302:isolation & purification; D003319:Corneal Stroma / Q000187:drug effects* / Q000382:microbiology; D003320:Corneal Ulcer / Q000188:drug therapy* / Q000382:microbiology; D015821:Eye Infections, Fungal / Q000188:drug therapy* / Q000382:microbiology; D005670:Fusarium / Q000302:isolation & purification*; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D011743:Pyrimidines / Q000008:administration & dosage*; D016896:Treatment Outcome; D014230:Triazoles / Q000008:administration & dosage*; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole