title: Assessment safety and efficacy of a combination therapy of topical amphotericin B and subconjunctival fluconazole for the treatment of fungal keratitis.
abstract: OBJECTIVE
  The study was aimed at evaluating the treatment of fungal keratitis using a combination therapy of a low concentration of topical amphotericin B (0.2 mg/mL) eye drops together with subconjunctival injections of 2 mg/mL of fluconazole.
  
  
  METHODS
  The study was carried out in the Ophthalmology Department of Zagazig University Hospital and included 12 patients with 12 pairs of eyes with resistant corneal ulcers that had the following clinical features suggesting fungal keratitis: thick elevated ulcer, feathery edge, and gutter formation. Cultures of corneal specimens were grown on Sabouraud agar medium. Topical amphotericin B eye drops in a concentration of 0.2 mg/mL in dextrose 5% were used every 2 hours for 21 days together with subconjunctival injections of fluconazole 2 mg/mL.
  
  
  RESULTS
  Among the eyes subjected to culture of corneal specimens, 8 eyes had positive results: Candida was detected in 5 eyes (66%) and filamentous fungi grew from the cultures of 3 eyes. Nine eyes improved as a result of treatment, showing complete healing of the ulcers (75%). Three cases showed no improvement (25%); 2 cases developed endophthalmitis; and 1 case was negative. A single case with corneal perforation had negative results on culture.
  
  
  CONCLUSIONS
  The use of a combination of topical amphotericin B eye drops at a concentration of 0.2 mg/mL in dextrose 5% with subconjunctival injection of fluconazole 2 mg/mL had the advantage of a lower incidence of the complications of local use of amphotericin B and a broader spectrum of antifungal coverage. This study reports a relatively high success rate of healing of fungal keratitis, with a significant reduction of the potential side effects of the local use of antifungal agents.
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, Zagazig University, Zagazig, Sharkia, Egypt. redaelmahdy2005@yahoo.com
authors.forename: Reda A
authors.initials: RA
authors.lastname: Mahdy
authors.forename: Waled M
authors.initials: WM
authors.lastname: Nada
authors.forename: Mostafa M
authors.initials: MM
authors.lastname: Wageh
authors.forename: Mohammad A
authors.initials: MA
authors.lastname: Kader
authors.forename: Mahmoud M
authors.initials: MM
authors.lastname: Saleh
authors.forename: Mahmoud M
authors.initials: MM
authors.lastname: Alswad
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002175:Candida / Q000302:isolation & purification; D003228:Conjunctiva; D003320:Corneal Ulcer / Q000188:drug therapy; D004359:Drug Therapy, Combination; D015821:Eye Infections, Fungal / Q000188:drug therapy* / Q000382:microbiology; D015725:Fluconazole / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005658:Fungi / Q000302:isolation & purification; D006801:Humans; D007267:Injections; D007634:Keratitis / Q000188:drug therapy* / Q000382:microbiology; D008875:Middle Aged; D009883:Ophthalmic Solutions; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D009883:Ophthalmic Solutions; D000666:Amphotericin B; D015725:Fluconazole