ESCRS - PO0639 - Modified Corneal Collagen Cross-Linking (M-Cxl) Combined With Intrastromal Injection Of Voriconazole For The Treatment Of Severe Fungal Keratitis With Ongoing Corneal Melting

Modified Corneal Collagen Cross-Linking (M-Cxl) Combined With Intrastromal Injection Of Voriconazole For The Treatment Of Severe Fungal Keratitis With Ongoing Corneal Melting

Published 2023 - 41st Congress of the ESCRS

Reference: PO0639 | Type: Free paper | DOI: 10.82333/3cky-kd23

Authors: Mohammed TAWFEEK* 1 , Ahmed Sherin M. Bayoumy 2 , Ashraf Bor’i 1 , Dalia Tohamy 3 , Ahmed M. Nashaat Ali Rady 4

1Ophthalmology,Zagazig University,Zagazig,Egypt, 2Ophthalmology,Benha University,Benha,Egypt, 3Ophthalmology,Assiut University,Assiut,Egypt, 4Ophthalmology,Merit University,Sohag,Egypt

Purpose

The aim of this work is to evaluate the safety and efficacy of repeated sessions of modified corneal collagen cross linking (M-CXL) combined with intrastromal injection of voriconazole for the treatment of severe fungal keratitis with ongoing corneal melting and compare the outcome with intrastromal injection of voriconazole alone.

Setting

El- Tayseer eye Hospital , Zagazig , Egypt.

Methods

This is a retrospective comparative clinical study. Thirty eyes with clinically suspected and lab-confirmed severe fungal keratitis with ongoing corneal melting were included. These eyes were classified randomly into two groups each of 15 eyes. In group (A), all the eyes underwent repeated sessions of M-CXL  till the reversal of corneal melting, then intrastromal injections of voriconazole were added each week till complete corneal healing together with negative culture on lab examination. In group (B), all the eyes underwent repeated intrastromal injections of voriconazole weekly together with frequent instillations (FI) of topical voriconazole till complete corneal healing with negative culture on lab examination.

Results

Successful treatment was reported in 13 eyes (86.7%) of group (A) which was better than that of group (B), 9 eyes (60%), while failure of treatment with complications was reported in 2 eyes (13.3%) which was less than group (B), 6 eyes (40%), with statistically significant difference (p <0.05) between the two groups. Visual improvement was observed in group (A) more than group (B).

Conclusions

M-CXL followed by intrastromal injection of voriconazole was found to be effective in treating severe fungal keratitis with ongoing corneal melting due to the known action of CXL for reversal of corneal melting and anti-infective properties. Our results revealed that combined M-CXL and intrastromal injection of voriconazole was safer than intrastromal injection of voriconazole alone for treating severe fungal keratitis with corneal melting with better visual outcomes.