Management of tunnel fungal infection with voriconazole

• Published in: Journal of cataract and refractive surgery Vol. 33; no. 5; pp. 915 - 917
• Main Authors: Jhanji, Vishal, MD, Sharma, Namrata, MD, Mannan, Rashim, MD, Titiyal, Jeewan S., MD, Vajpayee, Rasik B., MS, FRCSEd, FRANZCO
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.05.2007; Elsevier Science
• Subjects: Administration, Oral; Administration, Topical; Aged; Antifungal Agents - therapeutic use; Biological and medical sciences; Cataract Extraction; Corneal Ulcer - drug therapy; Corneal Ulcer - microbiology; Eye Infections, Fungal - drug therapy; Eye Infections, Fungal - microbiology; Female; Fusarium - isolation & purification; Humans; Medical sciences; Microsurgery; Mycoses - drug therapy; Mycoses - microbiology; Ophthalmology; Pyrimidines - therapeutic use; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the eye and orbit; Surgical Wound Infection - drug therapy; Surgical Wound Infection - microbiology; Triazoles - therapeutic use; Visual Acuity; Voriconazole; Infection; Antifungal agent; Clinical management; Treatment; Mycosis; Surgery; Voriconazole; Triazole derivatives; Management; Ophthalmology
• ISSN: 0886-3350; 1873-4502
• DOI: 10.1016/j.jcrs.2006.12.026

A 59-year-old woman presented 1 month after cataract surgery in the right eye with a stromal infiltrate at the site of the cataract surgery wound. The visual acuity was perception of light with accurate projection. Corneal scraping of the infiltrate revealed septate hyphae. There was no response to 6 weeks of therapy with topical fortified antibiotic agents and topical antifungal therapy in the form of natamycin 5%, amphotericin B 0.15%, and intracameral amphotericin B. The patient was started on oral voriconazole 200 mg twice daily and topical voriconazole 1% every hour, and resolution of the ulcer was noted within 3 days. At the 4-month follow-up, a visual acuity of 20/60 was achieved, with the formation of a vascularized corneal opacity superiorly. This case illustrates that topical and oral voriconazole may be used in the treatment of recalcitrant cases of fungal tunnel infections not responding to conventional antifungal therapy.