Successful Treatment Of Fungal Keratitis By Intracameral Amphotericin B

1. Che Mahiran Che Daud
2. Rohanah Alias
3. Thiageswari Umapathy

Ophthalmology Department, Hospital Kuala Lumpur, Malaysia

Purpose: To evaluate the effectiveness and safety of intracameral amphotericin B in treating deep fungal keratitis

Methods: A retrospective interventional 6 case series

Results: Retrospective interventional involving six cases of deep fungal keratitis that were unresponsive to topical antifungal therapy underwent intracameral injection of amphotericin B 0.01mg/0.1 ml.

The diagnosis of fungal infection was made on the basis of clinical evaluation, positive smear, and cultures of the fungus.

Topical antifungal therapy was started as soon as clinical diagnosis of fungal keratitis is made. The initial topical therapy included drops of 0.15% amphotericin B and fluconazole every hourly, 0.3% ciprofloxacin every two hourly, and drops of 1% homatropine sulfate thrice a day. Oral fluconazole 200mg daily was also started. When no objectively demonstrable response to therapy is seen in 7 days or infection shows signs of worsening, intracameral amphotericin B was given.

Patients were examined every third day and response to the therapy was recorded, including best-corrected visual acuity (BCVA) and measurement of size of abscess on slit-lamp biomicroscopy. The infection was considered resolved when there was complete healing of epithelial defect with resolution of corneal abscess and scar formation.

After intracameral injection of Amphotericin B, a faster reduction in the size of corneal infiltration was documented and a complete resolution of ulcers were seen within three weeks in all cases.

Conclusions: Targeted delivery of Amphotericin B by intracameral injection is safe and effective in treating cases deep seated fungal keratitis.