Supradescemetic voriconazole injection for Candida parapsilosis keratitis.

Abstract

PURPOSE:

To describe a technique for intracorneal application of voriconazole into the supradescemetic space in a case of deep recalcitrant Candida parapsilosis keratitis of a penetrating cornea graft.

METHODS:

A deep intracorneal incision reaching the center of the corneal infiltrate was created with a 20-gauge MVR blade. Then, a 27-gauge hydrodissection cannula was inserted deep into the corneal pocket, and 0.1 ml of voriconazole 0.5 mg/ml was injected until a bullous detachment of Descemet membrane (DM) covered 1/3 of the graft's area. DM detachment was documented by anterior segment optical coherence tomography (AS-OCT).

RESULTS:

AS-OCT confirmed the creation of a drug depot in the supradescemetic space, which partially regressed during the following hours; 24 h after the injection, a complete reattachment of DM was documented. After 4 weeks, the stromal infiltrate has cleared completely and no signs of recurrence were observed 3 months after injection.

CONCLUSION:

In the present case, the supradescemetic voriconazole injection led to resolution of a deep recalcitrant fungal infiltrate. The herein described technique could be tried in similar cases, where an intrastromal injection is indicated, as it may offer a larger intracorneal drug depot.

• Authors: Nikolaos Mamas, Konstantinos Andreanos, Klio Chatzistefanou, Petros Petrou, Dimitrios Brouzas, George Kymionis, Chrysanthi Koutsandrea, Konstantinos Droutsas
• Journal: International ophthalmology (Int Ophthalmol) Vol. 38 Issue 2 Pg. 849-854 (Apr 2018) ISSN: 1573-2630 [Electronic] Netherlands
• PMID: 28421398 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antifungal Agents
• Voriconazole

Topics

• Aged, 80 and over
• Antifungal Agents (administration & dosage)
• Candida parapsilosis (isolation & purification)
• Eye Infections, Fungal (drug therapy, microbiology)
• Humans
• Injections, Intraocular
• Keratitis (drug therapy, microbiology)
• Male
• Treatment Outcome
• Voriconazole (administration & dosage)