Ineffectiveness of intrastromal voriconazole for filamentous fungal keratitis

Masanori Niki, Hiroshi Eguchi, Yuki Hayashi, Tatsuro Miyamoto, Fumika Hotta, Yoshinori MitamuraDepartment of Ophthalmology, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima-shi, JapanPurpose: The purpose of this study is to describe the ineffectiveness of intr...

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Autores principales:	Niki M, Eguchi H, Hayashi Y, Miyamoto T, Hotta F, Mitamura Y
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2014
Materias:	Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/e7f94596673240099b4e47b840684a13
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spelling	oai:doaj.org-article:e7f94596673240099b4e47b840684a132021-12-02T08:02:35ZIneffectiveness of intrastromal voriconazole for filamentous fungal keratitis1177-5483https://doaj.org/article/e7f94596673240099b4e47b840684a132014-06-01T00:00:00Zhttp://www.dovepress.com/ineffectiveness-of-intrastromal-voriconazole-for-filamentous-fungal-ke-a17118https://doaj.org/toc/1177-5483 Masanori Niki, Hiroshi Eguchi, Yuki Hayashi, Tatsuro Miyamoto, Fumika Hotta, Yoshinori MitamuraDepartment of Ophthalmology, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima-shi, JapanPurpose: The purpose of this study is to describe the ineffectiveness of intrastromal voriconazole injection for filamentous fungal keratitis by contrasting the effectiveness for yeast keratitis.Methods: We examined seven fungal keratitis patients prospectively. All yeast was identified by molecular phylogenetic analyses of the chromosomal regions coding for the D1/D2 domain of the large-subunit 26S ribosomal RNA gene. All filamentous fungi were identified by the sequencing of internal transcribed spacers of the ribosomal DNA gene regions. Approximately 0.1 mL of voriconazole diluted with saline to 1.0% was injected with a 30-gauge needle inserted obliquely into the three to five clear cornea sites around the abscess. All subjects were administered natamycin ointment and oral itraconazole. When needed, intravenous micafungin, voriconazole, and/or intracameral voriconazole were added. Clinical courses were observed by the slit lamp microscope. Histopathology was examined when the corneas were removed.Results: All cases that were caused by yeast healed quickly after injections. Two cases of keratitis caused by Fusarium, and one case caused by Aspergillus, did not heal completely. In the Fusarium cases, additional antifungal medications (3.0% topical voriconazole and intravenous injection of micafungin) were needed. After optical penetrating keratoplasty in one of the cases, fungi were found in the deep stroma of the removed cornea. In the case of Aspergillus keratitis, pathological findings also showed fungi deep in the stroma of the removed cornea and the keratitis recurred after therapeutic penetrating keratoplasty.Conclusion: Intrastromal voriconazole injection is successful in treating yeast keratitis. However this is not the case for filamentous fungal keratitis.Keywords: voriconazole, intrastromal injection, filamentous fungal keratitisNiki MEguchi HHayashi YMiyamoto THotta FMitamura YDove Medical PressarticleOphthalmologyRE1-994ENClinical Ophthalmology, Vol 2014, Iss default, Pp 1075-1079 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Ophthalmology RE1-994
spellingShingle	Ophthalmology RE1-994 Niki M Eguchi H Hayashi Y Miyamoto T Hotta F Mitamura Y Ineffectiveness of intrastromal voriconazole for filamentous fungal keratitis
description	Masanori Niki, Hiroshi Eguchi, Yuki Hayashi, Tatsuro Miyamoto, Fumika Hotta, Yoshinori MitamuraDepartment of Ophthalmology, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima-shi, JapanPurpose: The purpose of this study is to describe the ineffectiveness of intrastromal voriconazole injection for filamentous fungal keratitis by contrasting the effectiveness for yeast keratitis.Methods: We examined seven fungal keratitis patients prospectively. All yeast was identified by molecular phylogenetic analyses of the chromosomal regions coding for the D1/D2 domain of the large-subunit 26S ribosomal RNA gene. All filamentous fungi were identified by the sequencing of internal transcribed spacers of the ribosomal DNA gene regions. Approximately 0.1 mL of voriconazole diluted with saline to 1.0% was injected with a 30-gauge needle inserted obliquely into the three to five clear cornea sites around the abscess. All subjects were administered natamycin ointment and oral itraconazole. When needed, intravenous micafungin, voriconazole, and/or intracameral voriconazole were added. Clinical courses were observed by the slit lamp microscope. Histopathology was examined when the corneas were removed.Results: All cases that were caused by yeast healed quickly after injections. Two cases of keratitis caused by Fusarium, and one case caused by Aspergillus, did not heal completely. In the Fusarium cases, additional antifungal medications (3.0% topical voriconazole and intravenous injection of micafungin) were needed. After optical penetrating keratoplasty in one of the cases, fungi were found in the deep stroma of the removed cornea. In the case of Aspergillus keratitis, pathological findings also showed fungi deep in the stroma of the removed cornea and the keratitis recurred after therapeutic penetrating keratoplasty.Conclusion: Intrastromal voriconazole injection is successful in treating yeast keratitis. However this is not the case for filamentous fungal keratitis.Keywords: voriconazole, intrastromal injection, filamentous fungal keratitis
format	article
author	Niki M Eguchi H Hayashi Y Miyamoto T Hotta F Mitamura Y
author_facet	Niki M Eguchi H Hayashi Y Miyamoto T Hotta F Mitamura Y
author_sort	Niki M
title	Ineffectiveness of intrastromal voriconazole for filamentous fungal keratitis
title_short	Ineffectiveness of intrastromal voriconazole for filamentous fungal keratitis
title_full	Ineffectiveness of intrastromal voriconazole for filamentous fungal keratitis
title_fullStr	Ineffectiveness of intrastromal voriconazole for filamentous fungal keratitis
title_full_unstemmed	Ineffectiveness of intrastromal voriconazole for filamentous fungal keratitis
title_sort	ineffectiveness of intrastromal voriconazole for filamentous fungal keratitis
publisher	Dove Medical Press
publishDate	2014
url	https://doaj.org/article/e7f94596673240099b4e47b840684a13
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Ineffectiveness of intrastromal voriconazole for filamentous fungal keratitis

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