Factors Affecting Treatment Outcomes With Voriconazole in Cases With Fungal Keratitis

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Purpose:To report clinical experience with the use of voriconazole for management of cases with fungal keratitis and to evaluate the factors affecting treatment outcomes.Methods:Retrospective database review of all cases with fungal keratitis that were treated with topical voriconazole at the Royal Victorian Eye and Ear Hospital, Melbourne, Australia, between January 2003 and July 2010, was undertaken. Main parameters evaluated were clinical and microbiological profile of the cases, treatment, and final outcomes.Results:A total of 26 cases were treated with voriconazole eye drops during the study period. In addition, voriconazole was used in the form of oral tablets (n = 16, 61.5%), intracorneal injection (n = 7, 26.9%), and intracameral injection (n = 2, 7.7%). Overall, 50% (n = 13) of cases responded to medical treatment. Further definitive surgical intervention in the form of penetrating keratoplasty was required in 11 cases (42.3%). Two cases (7.7%) underwent enucleation for severe nonresolving keratitis. Nonresponders were more likely to have peripheral infiltrates (38.5% vs. 7.7%, P = 0.16) and hypopyon (61.5% vs. 23%, P = 0.11) as compared with responders. There was no significant variation in the microbiological results between responders and nonresponders.Conclusions:Voriconazole was successful in the management of 50% cases of fungal keratitis in our study. Cases with peripheral infiltrates and hypopyon are less likely to respond to medical treatment.

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