UPDATE ON THE MANAGEMENT OF FUNGAL KERATITIS

Fungal keratitis (FK) presents a problem for the ophthalmologist as its control is limited by the availablility of effective antimycotics and the level to which they may infiltrate the corneal tissue. Photoactivated riboflavin and UV-A light have been trialed as potential adjuvant treatment for the management of corneal infections. It was shown that CXL and topical antibiotic therapy potentiate the effects of each other in the treatment of various origin keratitis. Silver is well known for its antimicrobial activity in a variety of physiological settings. Silver ions are generally recognized as the bioactive agent, supplied for clinical applications from numerous silver-containing formulations. We modified CXL by supplementing it with silver nanoparticle based drops(SNBD) during the procedure, using the synergistic effect of CXL and SNBD .
The aim of the study was to evaluate the efficiency of modified crosslinking (M-CXL) in the treatment of fungal keratitis.

The study took place at The S. Fyodorov Eye Microsurgery Federal State Institution including the one year follow-up.

The diagnosis of FK was made by confocal laser microscopy. M-CXL method involved simultaneous performance of CXL and frequent instillations of silver nanoparticle based eye drops (one drop every 3 minutes for 40 minutes). The study included 6 patients (6 eyes) with fungal keratitis.

The criteria for successful treatment were the absence of spread of the infiltrate, the absence of fungal hyphae confirmed by confocal laser microscopy, the absence of complaints and hypopyon, the elimination of the corneal syndrome. Complete suppression of fungal keratitis was achieved in 75% of cases after 28.25±5.5 days. 4 patients are under medical supervision. 2 patients underwent Penetrating Keratoplasty (PK) (2 and 6 months after M-CXL for each case).

In conclusion, the treatment of FK with modified Corneal Cross-linking (M-CXL) by using silver nanoparticle based eye drops is effective in inhibiting fungal sporulation and hyphal growth, and thus reduces the intensity of infection, which is guarantee of success for the use of more radical treatment methods such as Penetrating Keratoplasty.