Intrastromal voriconazole injection as a primary treatment of deep seated fungal corneal ulcer versus conventional treatment

To compare efficacy of intrastromal Voriconazole as a primary treatment of deep seated fungal corneal ulcer versus conventional treatment in form of 5% topical Natamycinin Northern India. A prospective, hospital based, interventional study was done between Jan 2022 to Jan 2023 in all deep seated fungal corneal ulcers involving half or more of corneal stromal depth. A total 30 patients (15 patients in each group) were studied. Groups were comparable in terms of age, gender, laterality, causative organism and size and depth of infiltrate. Mean age in intrastromal Voriconazole group was 40.5±19.2 and in topical 5% Natamycin group was 40.8±16. Out of the 15 patients in Natamycin group, 6(40%) patients did not show any improvement, worsening seen in 4(27%), improvement was noted in 3(20%) and 2(13%) patients were cured of fungal corneal ulcer. Out of 15 patients in intrastromal Voriconazole group, 7(47%) patients showed improvement, 6(40%) patients were cured and worsening of ulcer was noted in 2(13%) patients. On comparison, outcome between two groups was found to be statistically significant (p<0.006). 5% Natamycin is a drug of choice for fungal corneal ulcer, however, due to poor penetration of topical antifungal drugs, in deep seated fungal corneal ulceration and abscesses it was not found to be very effective. In these cases, due to broader spectrum of activity, higher achieved concentration at infection site and lower complication rate, intrastromal Voriconazole could be considered as a primary therapy. Further prospective studies with larger sample size are needed toestablish the outcome.