Effect of voriconazole and ultraviolet-A combination therapy compared to voriconazole single treatment on Fusarium solani fungal keratitis.

Abstract

PURPOSE:

To demonstrate that ultraviolet-A (UV-A) and voriconazole combination therapy is more effective than voriconazole single treatment for fungal keratitis.

METHODS:

The in vitro UV-A (375 nm) fungicidal effect was evaluated on Fusarium solani solutions. Each fungal solution was irradiated with different UV-A irradiation doses. Also, a fungal solution containing voriconazole was also irradiated with UV-A. The in vivo therapeutic effect of UV-A and voriconazole treatment was studied in a rabbit keratitis model. Fungi were injected intrastromally into the cornea of 16 rabbits. Each treatment was initiated 3 days after fungal injection and continued up to 8 days for the following groups: Group 1, control; Group 2, treated with UV-A once a day; Group 3, treated with voriconazole 3 times a day; Group 4, treated with voriconazole 3 times a day and UV-A once a day. On the last day, the sclera-cornea buttons were extracted and microbiological and histological evaluations were performed.

RESULTS:

The colony-forming units (CFUs) of fungal solutions in culture significantly decreased with UV-A irradiation. The CFUs of fungal solutions containing voriconazole also decreased with UV-A irradiation. In vivo, clinical scores of Group 3 (P=0.03) and Group 4 (P=0.02) 5 days after treatment were significantly lower compared to that of Group 1. The clinical score of Group 4 (P=0.03) 5 days after treatment was significantly lower compared to that of Group 3. The histopathological scores 5 days after treatment were significantly lower in Group 4 compared to those of Group 1 (P<0.01) and Group 3 (P=0.02). Based on our CFU analysis, only Group 4 showed significantly lower CFUs compared to Group 1 (P=0.04).

CONCLUSIONS:

UV-A and voriconazole combination treatment could be a safe and effective alternative to voriconazole single treatment for fungal keratitis.

• Authors: Kyoung Sub Choi, Sang Chul Yoon, Tyler Hyung Taek Rim, Soo Jung Han, Eun-Do Kim, Kyoung Yul Seo
• Journal: Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics (J Ocul Pharmacol Ther) Vol. 30 Issue 5 Pg. 381-6 (Jun 2014) ISSN: 1557-7732 [Electronic] United States
• PMID: 24724576 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antifungal Agents
• Voriconazole

Topics

• Animals
• Antifungal Agents (administration & dosage)
• Combined Modality Therapy (methods)
• Eye Infections, Fungal (pathology, therapy)
• Fusariosis (pathology, therapy)
• Fusarium (drug effects, isolation & purification, radiation effects)
• Humans
• Keratitis (pathology, therapy)
• Rabbits
• Treatment Outcome
• Ultraviolet Therapy (methods)
• Voriconazole (administration & dosage)