Clinical results of topical fluconazole for the treatment of filamentous fungal keratitis.

BACKGROUND: Fungal keratitis is a rare but serious condition that may result in loss of vision. The potentially poor prognosis might be due to a delay in diagnosis and/or to limited treatment options. The aim of this study is to evaluate the clinical outcome of patients treated with topical fluconazole 0.2% for the treatment of filamentous fungal keratitis. METHODS: Retrospective case series. A chart review of all patients evaluated at the Ophthalmology Department of the Hospital de Clínicas in Paraguay from January 1997 to December 2000 identified 25 cases of fungal keratitis. Among these cases, one patient discontinued the treatment and another received amphotericin as the first line drug, resulting in 23 cases available for data analysis. Twelve patients were treated with topical fluconazole 0.2% alone (Group I) and 11 patients received a combination of topical fluconazole 0.2% and oral ketoconazole 200 mg twice daily (Group II). RESULTS: Sixteen of 23 cases showed resolution of the keratitis, 9/12 (75%) in Group I and 7/11 (64%) in Group II. Seven patients (30%) did not respond to medical treatment and required a surgical procedure to preserve eye integrity. Superficial and small ulcers have a significantly better prognosis than do lrge and deep ulcers. Concomitant oral ketoconazole (400 mg/day) did not improve the clinical results. CONCLUSIONS: Our findings of study suggest that topical fluconazole 0.2% is a safe and effective antifungal drug for the management of filamentous mycotic keratitis, particularly in cases that are not severe. The addition of oral ketoconazole to topical fluconazole did not improve the clinical outcome.

A direct method to measure the power of the central cornea after myopic laser in situ keratomileusis.

OBJECTIVE: To measure the corneal power after myopic laser in situ keratomileusis (LASIK). METHODS: Six central areas in 6 corneal power maps were studied using the Orbscan II statistical analysis device in 26 eyes that underwent myopic LASIK. Refractive and corneal power changes were compared. Factors related to wrong corneal power measurement were evaluated. MAIN OUTCOME MEASURES: Cycloplegic refraction, refractive change at the corneal plane, and Orbscan II corneal power maps. RESULTS: Preoperatively, only posterior-mean power (P<<.001) and anterior-posterior power ratio (P<<.001) varied according to the size of the analyzed area. Postoperatively, total-optical (P =.03), keratometric-mean (P =.04), total-mean (P<.001), anterior-mean (P =.03), and posterior-mean (P<<.001) powers; and anterior-posterior power ratio (P<<.001) varied according to the area. Postoperatively, the difference between keratometric-mean and total-mean powers became larger (P<.001), and the anterior-posterior power ratio was reduced (P<<.001). A posterior-mean power change occurred (P =.04). Refractive change after myopic LASIK was best estimated by 2-mm total-mean power (mean +/- SD difference, 0.07 +/- 0.62 diopters [D]; P =.55) and 4-mm total-optical power (mean +/- SD difference, -0.08 +/- 0.53 D; P =.37). CONCLUSIONS: Total corneal power is more positive and refractive change is underestimated when deduced from the anterior surface radius and keratometric refractive index. The anterior-posterior power ratio is not a fixed value. The best area to estimate the refractive change depends on the method used to obtain the power in diopters. Refractive change tended to be underestimated in larger areas and higher preoperative myopia. Orbscan II total-mean and total-optical power maps accurately assess the corneal power after myopic LASIK independent of preoperative data or correcting factors, and should improve intraocular lens calculation.