INTRASTROMAL VORICONAZOLE TREATMENT IN A RARE CASE OF FUNGAL KERATITIS: A CASE REPORT

The aim of this case report is to evaluate the response of Alternaria keratitis, a difficult-to-treat fungal keratitis,intrastromal treatment.

The case was managed at Department of Ophthalmology, Duzce University Hospital, Duzce, Türkiye

 20 days previously,a 62-year-old female patient presented with complaints of pain and stinging in her right eye. The patient had suffered an eye trauma while working in the garden and had previously received antibacterial treatment (moxifloxacin 0.5% four times a day) for 2 weeks. In the right eye, BVCA (best corrected visual acuity) was 180/200, an irregularly bordered gray-white lesion on the corneal periphery, raised from the corneal surface, and conjunctival hyperemia were observed.After antibacterial treatment was discontinued for 24 hours, corneal swabs and lesion scrapings were taken, and then,in addition to antibacterial topical treatment, topical fungal treatment (voriconazole 1% eight times a day), artificial tears and mydriatic(tropicamide 0.5%three times a day) were added. Microbiological examination revealed growth of Alternaria alternata, and the patient received an intrastromal voriconazole injection in addition to topical treatment in the right eye. Following treatment, the keratitis focus shrank and the epithelium healed, and the patient's visual acuity improved to 200/200 with correction.

Due to the inadequacy of topical treatment in fungal infections that invade the deep layers of the cornea, many methods are being assessed to evaluate the effectiveness of proven drugs using different methods . Our rare case demonstrates that intrastromal voriconazole, administered inaddition to topical treatment, may be effective in improving treatment response in patients with refractory fungal keratitisrequiring long-termtreatment and who cannot receive systemic treatment due to their side effect profile.