Use of Voriconazole in the Treatment of Fungal Keratitis

Ocular fungal infections most commonly affect the cornea, anterior chamber, and vitreous. Fungal keratitis is uncommon, accounting for only 6% to 20% of infectious keratitis when compared with bacterial keratitis. The prevalence of fungal keratitis is markedly higher in Asia, accounting for 44% of all corneal ulcers in South India. Despite being a less common cause of microbial keratitis, fungus comprises about 50% of all microbial keratitis cases requiring therapeutic penetrating keratoplasty (PK). Transplants done for fungal keratitis have the poorest prognosis for survival when compared with transplants done for other types of nonviral microbial keratitis. Fungal keratitis is predominantly an opportunistic infection seen in rural settings. The major risk factors are trauma (especially with vegetable matter), contact lens wear, use of topical steroids or antibiotics, and topical anesthetic abuse. Other risk factors include vernal or allergic keratoconjunctivitis, incisional refractive surgery, and neurotrophic corneas secondary to varicella-zoster and herpes simplex viruses, keratoplasty, systemic immunosuppression, chronic illness, and hospitalization. The most common organisms isolated from fungal corneal ulcers are Aspergillus spp. and Candida spp. Fusarium spp. predominates in the southern United States. It is possible for fungal keratitis to progress to scleritis and/or endophthalmitis. Therefore, it is critical to employ effective therapy as early as possible. Fungal infections are notoriously difficult to manage