Dr. Ravi Kant Bamotra, Dr. Sudesh Kumar Arya, Dr. Amit Raj, Dr. Meenakshi
Aim: To report the result of intra-stromal voriconazole in recalcitrant keratomycosis.
Method: We present four cases of refractory fungal keratitis. All the cases were resistant to topical 5% natamycin and 1 % voriconazole and therefore, intra-stromal voriconazole reconstituted to 50 microns / 0.1 ml was injected circumferentially into the mid-stroma in close proximity to the ulcer margins.
Result : A marked reduction in the size of ulcer was noted at 72 hours after intra-stromal voriconazole in all patients. Repeat injection were given as and when required. No complications were seen in any of the cases.
Conclusion: Intra-stromal voriconazole offers an effective adjunctive in treating refractory keratomycosis as the direct deposition of drug into deeper stroma results into higher therapeutic concentrations into ulcer; thus obviating the need for therapeutic penetrating keratoplasty in such patients.