Ineffectiveness of intrastromal voriconazole for filamentous fungal keratitis

Figures & data

Table 1 Epidemiological data and outcomes of all subjects

Case	Age (years)	Sex	1st BCVA	Pathogen	MIC of voriconazole (μg/mL)	Size of opacity* (mm)	Number of injections	Additional medication	Outcome	Post BCVA
1	60	F	HM	Candida parapsilosis	0.015	4×3	2	PMR-o, ITCZ MFLX-d	Healed	20/40
2	61	F	HM	Candida parapsilosis	0.015	3×3	5	PMR-o, ITCZ MFLX-d	Healed	20/200
3	84	F	LP	Candida albicans	0.06	2×3	1	PMR-o, MFLX-d	Healed	HM
4	86	F	LP	Aspergillus flavus	0.5	11×11	6	PMR-o, ITCZ, MCFG-iv, VRCZ-ici, MFLX-d	Recurred	LP
5	73	M	20/2000	Fusarium species	4	4×3	6	PMR-o, ITCZ, MCFG-iv, VRCZ-iv, MFLX-d	Recurred	20/800
6	78	F	HM	Fusarium proliferatum	4	11×10	7	PMR-o, ITCZ MCFG-iv, LVFX-d	Recurred	LP
7	64	M	20/2000	Candida parapsilosis	≤0.015	3×4	1	PMR-o, ITCZ	Healed	20/200

Note:

* Longitudinal diameter and transverse diameter.

Abbreviations: 1st BCVA, best corrected visual acuity at first visit; -d, eye drop; F, female; HM, hand motion; ici, intracameral injection; ITCZ, itraconazole 50 mg oral administration; iv, intravenous injection; LP, light perception; LVFX, levofloxacin; M, male; MCFG, micafungin; VRCZ, voriconazole; MFLX, moxifloxacin; MIC, minimum inhibitory concentration; PMR-o, natamycin ointment; Post BCVA, posttreatment best corrected visual acuity.

Figure 1 Case 4 (pre-injection). The corneal abscess caused by Aspergillus flavus has spread to most of the grafted cornea.

Figure 2 Case 4. Pathological findings of the removed cornea (Grocott’s staining). A substantial amount of fungi are observed just above the Descemet’s membrane.

Figure 3 Optical coherence tomography images of Case 1 (pre- and post-injection).

Notes: Intrastromal fluid location just after the injection of voriconazole can be seen in the right picture. The high-density area is limited to the outermost two-thirds or three-fourths of the corneal stroma (white arrows).

Figure 4 Case 5 (the anterior picture at the initial visit).

Note: The hyphate ulcer and the corneal perforation are observed.

Figure 5 Case 5 (pathological findings of the removed cornea) (Grocott’s staining).

Note: Hyphae is observed in the deep layers of the corneal stroma.