Topical versus Intrastromal Voriconazole for treatment of Recalcitrant fungal Corneal Ulcer: A Randomised Controlled Trial

Purpose: To compare the safety and efficacy of intrastromalvoriconazole injection
with topical voriconazole in management of fungal corneal ulcer not responding to
conventional therapy.Patients and methods: A comparative and randomized study
performed on patients with resistant fungal keratitis.Half of the patients (Group A)
were given intrastromal injection in the dose of 0.1 ml (50 microgram/0.1ml) in each
injection , Half of the patients (Group B) were given topical voriconazole eye drops
(1%) once hourly. Healing of keratitis was considered as primary outcome
measure.Results: Each group included 35 eyes with resistant fungal keratitis. Complete
healing of fungal keratitis was higher in group A (88.6%) than in group B (31.4%) and
the difference was statistically significant (P<0.05). Duration of healing ranged
between 2-4 weeks in group A and between 2-6 weeks in group B
(P>0.05).Conclusion: Voriconazole topically might be effective for treatment of
resistant fungal keratitis. Adding intrastromal injection to topical drops could
significantly raise the healing rate and hasten the resolution period without significant
complications related to injection.