Topical versus Intrastromal Voriconazole for treatment of Recalcitrant fungal Corneal Ulcer: A Randomised Controlled Trial

Purpose: To compare the safety and efficacy of intrastromalvoriconazole injectionwith topical voriconazole in management of fungal corneal ulcer not responding toconventional therapy.Patients and methods: A comparative and randomized studyperformed on patients with resistant fungal keratitis.Half of the patients (Group A)were given intrastromal injection in the dose of 0.1 ml (50 microgram/0.1ml) in eachinjection , Half of the patients (Group B) were given topical voriconazole eye drops(1%) once hourly. Healing of keratitis was considered as primary outcomemeasure.Results: Each group included 35 eyes with resistant fungal keratitis. Completehealing of fungal keratitis was higher in group A (88.6%) than in group B (31.4%) andthe difference was statistically significant (P<0.05). Duration of healing rangedbetween 2-4 weeks in group A and between 2-6 weeks in group B(P>0.05).Conclusion: Voriconazole topically might be effective for treatment ofresistant fungal keratitis. Adding intrastromal injection to topical drops couldsignificantly raise the healing rate and hasten the resolution period without significantcomplications related to injection.