Effect of voriconazole and ultraviolet-A combination therapy compared to voriconazole single treatment on Fusarium solani fungal keratitis.
OBJECTIVE
To demonstrate that ultraviolet-A (UV-A) and voriconazole combination therapy is more effective than voriconazole single treatment for fungal keratitis.


METHODS
The in vitro UV-A (375 nm) fungicidal effect was evaluated on Fusarium solani solutions. Each fungal solution was irradiated with different UV-A irradiation doses. Also, a fungal solution containing voriconazole was also irradiated with UV-A. The in vivo therapeutic effect of UV-A and voriconazole treatment was studied in a rabbit keratitis model. Fungi were injected intrastromally into the cornea of 16 rabbits. Each treatment was initiated 3 days after fungal injection and continued up to 8 days for the following groups: Group 1, control; Group 2, treated with UV-A once a day; Group 3, treated with voriconazole 3 times a day; Group 4, treated with voriconazole 3 times a day and UV-A once a day. On the last day, the sclera-cornea buttons were extracted and microbiological and histological evaluations were performed.


RESULTS
The colony-forming units (CFUs) of fungal solutions in culture significantly decreased with UV-A irradiation. The CFUs of fungal solutions containing voriconazole also decreased with UV-A irradiation. In vivo, clinical scores of Group 3 (P=0.03) and Group 4 (P=0.02) 5 days after treatment were significantly lower compared to that of Group 1. The clinical score of Group 4 (P=0.03) 5 days after treatment was significantly lower compared to that of Group 3. The histopathological scores 5 days after treatment were significantly lower in Group 4 compared to those of Group 1 (P<0.01) and Group 3 (P=0.02). Based on our CFU analysis, only Group 4 showed significantly lower CFUs compared to Group 1 (P=0.04).


CONCLUSIONS
UV-A and voriconazole combination treatment could be a safe and effective alternative to voriconazole single treatment for fungal keratitis.
1 Graduate School of Yonsei University , Seoul, South Korea .
Kyoung Sub
KS
Choi
Sang Chul
SC
Yoon
Tyler Hyung Taek
TH
Rim
Soo Jung
SJ
Han
Eun-Do
ED
Kim
Kyoung Yul
KY
Seo
D000818:Animals; D000935:Antifungal Agents / Q000008:administration & dosage; D003131:Combined Modality Therapy / Q000379:methods; D015821:Eye Infections, Fungal / Q000473:pathology / Q000628:therapy*; D060585:Fusariosis / Q000473:pathology / Q000628:therapy*; D005670:Fusarium / Q000187:drug effects / Q000302:isolation & purification* / Q000528:radiation effects; D006801:Humans; D007634:Keratitis / Q000473:pathology / Q000628:therapy*; D011817:Rabbits; D016896:Treatment Outcome; D014467:Ultraviolet Therapy / Q000379:methods*; D065819:Voriconazole / Q000008:administration & dosage*
D000935:Antifungal Agents; D065819:Voriconazole