INTRASTROMAL VORICONAZOLE AS A PRIMARY TREATMENT FOR CLINICALLY DIAGNOSED FUNGAL KERATITIS IN CHILDREN.

Abstract

Purpose: to evaluate the outcome of voriconazole intrastromal injection as a primary treatment of clinically presumed fungal keratitis in pediatric age. Methods: Retrospective study performed in a tertiary care hospital and included 13 eyes of 13 children less than 18 years old presented with feathery corneal infiltration after trauma with organic material. Intrastromal voriconazole injection (200ug/0.1 ml) was done upon clinical diagnosis of fungal keratitis followed by topical antifungal eye drops. Reinjection was done after 48 hours of the 1st injection if no clinical improvement found. Outcome measures were the response to treatment, number of injections, duration of hospitalization and complications. Results: The mean age of children included was 7± 2.8 years (range: 4-12 years). Ten cases (77%) had clinical improvement after 24 hours of single intrastromal injection. One case improved after a second intrastromal injection of voriconazole and two cases had three injections before clinical improvement. Duration of hospitalization ranged from 2–7 days (2.5 ± 0.8 days). After 3 months of follow up all cases developed localized corneal opacity and none developed recurrence of infection. Conclusions: Early intracorneal injection of voriconazole is a safe and effective way to treat cases of fungal keratitis in children.