Clinical Efficacy of Topical Voriconazole as Treatment in Culture-Positive Fungal Keratitis

PURPOSE: To evaluate the efficacy of topical voriconazole in treatment of culture-positive fungal keratitis. METHODS: Twenty-two cases of culture-positive fungal keratitis treated with topical anti-fungal drugs from October 2004 to December 2010 were evaluated and medical records were reviewed. Patients were divided into 3 groups according to the method of topical antifungal treatment; the first group (V, n = 6) received voriconazole monotherapy, the second group (V+, n = 10) received topical voriconazole and amphotericin B combined therapy, and the third group (A, n = 6) received amphotericin B monotherapy. RESULTS: The treatment success rate between the 3 groups was not significantly different. The epithelial defect healing time of group V was shorter than group V+. Treatment failure risk factors included Fusarium spp. infection and the presence of hypopyon. Eight eyes received topical voriconazole maintenance therapy for 66 days and there were no corneal erosions or epithelial defects. CONCLUSIONS: In fungal keratitis, topical voriconazole is as effective as other standard treatments and provides a faster healing time in the corneal epithelium than other standard treatments. However, voriconazole should be used with caution and therapeutic surgery should be considered in Fusarium spp. infections.

The Short-Term Effect of Limbal Relaxing Incision and Compression Suture on Post-Penetrating Keratoplasty Astigmatism

PURPOSE: To investigate the short-term effect of limbal relaxing incisions accompanied by compression sutures on postoperative astigmatism in penetrating keratoplasty. METHODS: The medical records of patients who underwent penetrating keratoplasty, were followed-up for at least 18 months and had residual astigmatism greater than 4.0 diopters (D), were retrospectively analyzed. The patients had paired limbal relaxing incisions on the steep axis and compression sutures on the flat axis. The paired limbal relaxing incision was done for 2 clock hours each with a depth of 85% of the corneal thickness, and the compression sutures with an average of 3.2 bites were added with a Troutman operating keratometer guide. The visual acuities, corneal astigmatism and complications were evaluated at 1 month and 6 months. RESULTS: At 1 month after the surgery, the best corrected visual acuities (log MAR) improved from 0.840 to 0.674 (p = 0.037) except for 1 patient with immediate postoperative rejection and another patient with a pre-existing cataract. The mean corneal astigmatism was reduced from 9.118 +/- 3.158 D to 4.982 +/- 3.063 D (p = 0.021). At 6 months after the surgery, the mean corneal astigmatism increased to 5.489 +/- 2.670 D (p = 0.008), and the effect of surgery became statistically insignificant (p = 0.477). CONCLUSIONS: Paired limbal relaxing incisions and compression sutures were effective short-term on reducing residual corneal astigmatism and improving visual acuities in keratoplasty patients with high astigmatism, but became less effective on corneal astigmatism at 6 months.