Topical and Intracameral Voriconazole for the Treatment of Refractory Fusarium Keratitis

Dr. Merce MorralInstitut Clínic d’Oftalmologia

Barnaclínic+Hospital Clinic i Provincial de Barcelona

ESCRS Winter Meeting, February 2012

I have no financial interests to disclose

• 72-y-o female

• Contact lens wearer

• Empirical fortified broad-spectrum antibiotics (Vancomycin and Ceftazidime)

03/03/09 20/100

Corneal cultures: Fusarium sppTopical Amphotericin B

17/03/09 HM

Corneal cultures: Fusarium sppTopical Amphotericin B

17/03/09 HM

• Lack of clinical improvement

• Full-thickness corneal abscess with endothelial involvement

31/03/09 HM

• Intracameral Voriconazole 10 microg/0.1mL + Amphotericin B 5 microg/0.1mL

• Topical Voriconazole 1% (hourly, slowly tapered down for 2 months) – no Natamycin available

• Voriconazole po 200mg BID 03/04/09 HM

Natamycin, Voriconazole and Posaconazole bestAmphotericin poor1

1. Lalitha P, et al. Antimicrobial Susceptibility of Fusarium, Aspergillus, and Other Filamentous Fungi Isolated From Keratitis. Arch Ophth 2007;125:789-793

21/04/09 20/100

06/10/09 20/100

26/01/10

09/02/10 20/25

20/80

140º -7.00 +4.00

90º -6.00 +4.50

16/01/12 20/20

120º -7.50 0.00

Conclusions• Topical and intracameral Voriconazole were effective to treat a case of

severe Fusarium Keratitis refractory to Amphotericin B

• Treatment of fungal keratitis is still challenging

• Although new antifungal agents are available, clinical experience with these agents is sparse, and the availability of topical antifungals is limited

• Antifungal sensitivity tests are not rutinely performed in clinical practice -treatment is typically empirical

• Correlation between in vitro susceptibilities and in vivo clinical results still unclear