The Role Of Intrastromal Injections In The Management Of Fungal Keratitis

To evaluate the effectiveness of intrastromal injections in the management of fungal keratitis. 

As infectious fungal keratitis, is a diagnostic and therapeutic emergency. The visual prognosis is often threatened, which requires rapid and elaborate treatment. Intrastromal injections of antifungals may be necessary, particularly in the case of deep stromal damage not responding to topical treatment. We describe a case of corneal abscess, which showed a favorable evolution under treatment with intrastromal injections of antifungals.

The adult ophthalmology department, of the 20 August 1953’s university hospital center, Casablanca, Morocco. 

We report a case of mrs. B.K, hospitalized for a corneal abscess of the right eye. She presented with a painful red eye and a decreased visual acuity, following the use of a kohl pencil and self-medication by medicinal herbs « Mugwort ».

Her slit-lamp examination found a visual acuity at hand motion, a conjunctival hyperemia, an important corneal edema, some Descemet membrane folds, a temporal para-axial stromal infiltration of 4.2*4.1 mm with some satellite infiltrates.

The medical treatment was based on fortified eye drops of Ceftazidime,Vancomycin and Voriconazole, with oral antibiotic therapy, without any improvement.

Then we initiated 3 intrastromal injections of Voriconazole, spaced by one week. 

Our patient’s evolution was marked by an increased visual acuity, a reduction in infiltration and healing of the ulceration showed on the AS-OCT.

Fungal keratitis represent 15% of all infectious keratitis. Their incidence is associated with corneal trauma, wearing contact lenses, intensive use of corticosteroids and immunosuppressants. 

Due to difficulty of treatment and poor prognosis, the management of deep fungal keratitis requires alternative pathways to topical or oral administration of antifungals, such as intrastromal injections of antifungals.

The stromal injection technique used in our patient presents many advantages : targeted delivery, better penetration, slow drug release and less epithelial toxicity.

Infectious fungal keratitis is a major cause of vision loss and blindness.

Rapid diagnosis and targeted treatment are essential to its management.

Intrastomal injections are an effective mean of administering antifungals directly to the site of infection, and thus allowing appropriate management of deep and recalcitrant fungal keratitis.