Evaluation of liposomal amphotericin B for the treatment of fungal keratitis in a tertiary eye care hospital

• Published in: Indian journal of ophthalmology Vol. 71; no. 2; pp. 518 - 523
• Main Authors: Kumar, Vishal, Kumari, Pooja, Lomi, Neiwete, Vanathi, Murugesan, Gupta, Noopur, Tandon, Radhika, Velpandian, T, Ahmed, Nishat, Satpathy, Gita
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer India Pvt. Ltd 01.02.2023; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd; Wolters Kluwer - Medknow; Wolters Kluwer Medknow Publications
• Subjects: Acuity; Adult; Amphotericin B; Amphotericin B - therapeutic use; Antifungal Agents - therapeutic use; clinical efficacy; Confocal microscopy; Cornea; Corneal Ulcer - microbiology; Dosage and administration; Drug therapy; Eye Infections, Fungal - diagnosis; Eye Infections, Fungal - drug therapy; Eye Infections, Fungal - microbiology; fungal keratitis; Hospitals; Humans; Keratitis; liposomal amphotericin b; Liposomes; Middle Aged; Original; Patients; Potassium hydroxide; Statistical analysis; Testing; Ulcers; Vascularization; India; liposomal amphotericin B; fungal keratitis; Clinical efficacy
• DOI: 10.4103/ijo.IJO_1474_22
• ISSN: 0301-4738

Purpose: To evaluate the efficacy of liposomal amphotericin B (L-AMB) for the treatment of fungal keratitis. Methods: Patients with fungal keratitis confirmed by potassium hydroxide (KOH) smear and/or confocal microscopy were administered topical L-AMB and randomized into three groups treated with three different formulations. The medication was administered two hourly till clinical improvement was achieved, followed by six hourly till complete resolution. The outcome measures were time to clinical improvement, resolution of epithelial defect, stromal infiltrate, hypopyon, extent and density of corneal opacity, neovascularization, and best corrected visual acuity (BCVA) at 3 months. Results: Mean age of the patients was 46.6 ± 14.8 years, and trauma with vegetative matter was the most common predisposing factor. Aspergillus flavus (36%) was the most common fungus cultured, followed by Fusarium (23%). Mean time to clinical improvement, time to resolution of epithelial defect, mean time to resolution of infiltrate, and time to resolution of hypopyon were 3.45 ± 1.38, 25.35 ± 8.46, 37.97 ± 9.94, and 13.33 ± 4.90 days, respectively, and they were comparable among the three groups. There was a significant difference between treatment failure and success cases in terms of days of presentation (P < 0.01), size of the epithelial defect (P-value 0.04), and infiltrate size at presentation (P-value 0.04). At 3 months follow-up, no statistically significant difference was noted in BCVA and mean scar size among groups. Conclusion: L-AMB in a gel form is an effective antifungal agent that promotes the healing of fungal ulcers with notably least vascularization and better tolerance. Trial registration number: CTRI/2020/04/024550