Role of intrastromal voriconazole in recalcitrant fungal keratitis

Objectives: To study role of intrastromal voriconazole in recalcitrant fungal Keratitis.Material and Methods: 30 cases of fungal keratitis who were having >50% stromal thickness involvement and not showing good response to topical Natamycin (5%) and topical Voriconazole (1%) eye drops were included in the study. Cases with impending or frank perforation, involvement of sclera or endophthalmitis were excluded from the study. 50 microgram/0.1 ml of Voriconazole was injected with a 30G needle in midstoma, divided equally in all four quadrants. 1% voriconazole eye drops were also continued. Cases were examined daily for 1 week and then every week for 4 weeks.Results: Out of 30 patients, 24 patients (80%) showed significant improvement after 4 week, 3 patients (10%) did not show any improvement and 3 patients (10%) got worsened and ultimately managed with therapeutic keratoplasty.Conclusion: Intrastromal voriconazole is highly efficacious in recalcitrant fungal keratitis. It is just an OPD procedure. It may not only save the eye but less number of patients will require therapeutic keratoplasty.