Efficacy of corneal debridement combined with intrastromal voriconazole injection as adjunctive therapy for recalcitrant fungal keratitis

Fungal keratitis is a serious cause of blindness worldwide, especially in developing countries. Many trial were done to accelerate healing and improve outcome of recalcitrant fungal keratitis unresponsive to standard clinical treatment. To evaluate the efficacy of corneal debridement combined with intrastromal voriconazole injection as an adjunctive treatment for recalcitrant mycotic keratitis. This prospective randomized interventional study was carried out on 40 eyes of 40 patients with resistant fungal corneal ulcers. Patients were equally divided into two groups: in one group, corneal debridement combined with intrastromal voriconazole in the same setting (group A) was done as adjunctive therapy to topical treatment, and in the other group, only topical antifungal therapy was used guided with culture and sensitivity results (group B). All patients were subjected to ophthalmic examination and were followed-up daily for the first week then weekly till complete healing. Healing was achieved in 95% of cases of group A at the fourth week while healing was achieved in group B in only 55% of cases at the same duration with a statistically significant difference between both groups (X2=14.983, P = 0.002). No cases required amniotic membrane transplantation (AMT) in group A while 4 cases in group B required AMT due to thinning. Corneal debridement combined with intrastromal injection of voriconazole may offer a good option as adjunctive therapy to traditional topical therapy for recalcitrant fungal keratitis and may shorten the duration of the treatment with faster recovery of vision.