Official ESCRS | European Society of Cataract & Refractive Surgeons


Management of end-stage fungal corneal ulceration with off-label treatment

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Session Details

Session Title: Presented Poster Session: Corneal Cross-Linking

Venue: Poster Village: Pod 3

First Author: : C.Tsenikoglou GREECE

Co Author(s): :    K. Boboridis   F. Topouzis                    

Abstract Details


To report the successful management of fungal corneal ulceration not amenable to conventional ophthalmic medications.


Two female patients (2 eyes) with long standing recurrent corneal ulceration not improving with empiric topical antibacterial treatment were referred to our ocular surface department. Corneal scraping revealed Fusarium fungus and treatment with topical voriconazole showed no effect two weeks later, progressing to impending perforation with hypopyon.


Due to lack of available treatment alternatives and before proceeding to evisceration we introduced an off label topical ophthalmic treatment with ketoconazole (20mg /g) skin cream 4 times daily.


In both cases hypopyon resolved in two weeks and the deep central ulceration healed with complete epithelialization in 4 weeks. We continued topical treatment twice daily for two additional weeks to prevent further recurrence.


Despite the relatively low incidence of culture-proven fungal keratitis and in the absence of effective branded topical medications, ketoconazole skin cream appears effective and safe off label treatment for persistent fungal corneal ulcers from Fusarium fungus.

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