Voriconazole: A Step Ahead in Management of Fungal Corneal Ulcer?

Swapnil Parchand

Purpose: To study the efficacy of systemic and topical Voriconazole in the management of severe keratomycosis.

Design: Prospective randomized interventional controlled study.

Methods: Setting: Cornea sevices at tertiary care teaching hospital. PATIENTS: 45 eyes with microbiologically proven severe fungal corneal ulcer.

Procedure: 45 eyes were randomly divided into three groups. Group I (15 eyes) received oral Voriconazole and topical Voriconazole 1 %, group II (15 eyes) received oral Voriconazole and topical Natamycin 5 % and group III (15 eyes) received conventional treatment in the form of oral Itraconazole and topical Natamycin 5 %. All the patients were followed up every 48 hours till the epithelial defect and corneal infiltrates resolved completely.

Outcome Measures: Time for resolution of hypopyon, epithelial defect and infiltrate.

Results: Each group had 15 eyes. Successful resolution was found in 10 (66.7 % eyes) in group I, 11 (73.3 % eyes) in group II and 10 (66.6 % eyes) in group III respectively. Average time for resolution of hypopyon was 9.8±1.7, 12.3±3.6, and 16±10.5 days (P = 0.231), epithelial defect was 31.1±11.4, 29.2±8.2 and 31.8±11.4 days (P = 0.837) and for resolution of infiltrate was 36.8±10.6, 38.8±8.9 and 36.7±10.4 days in group I, II and III respectively (P = 0.860).

Conclusions: We found voriconazole equally efficacious and safe drug as compared to conventional antifungal therapy in the treatment of severe keratomycosis. However, patients receiving oral voriconazole plus topical natamycin had the best treatment outcomes as well as the least frequency of surgical intervention.