Role of Topical Fumagillin 0.007% in the Management of Microsporidial Stromal Keratitis: Interventional Pilot Study with Literature Review.

Purpose: The standard management of Microsporidial Stromal Keratitis (MSK) traditionally involves therapeutic penetrating keratoplasty, often accompanied by complications. This pilot study investigated medical management, evaluating outcomes using topical fumagillin alone or in combination with topical voriconazole and oral albendazole.

Methods: Mild to moderate MSK cases (January 2019-2024) with informed consent were included. The diagnosis was confirmed by microsporidial spores on smear (potassium hydroxide with calcofluor white, Gram, or modified Ziehl-Neelsen stain). Patients received 0.007% topical fumagillin (Sigma-Aldrich, F6771) alone or with topical voriconazole and oral albendazole.

Results: Five patients (six eyes, 17.2%) of 29 MSK cases were enrolled, all males, with a mean age of 52.4 ± 12.3 years (37-74). Symptoms lasted 5.2 ± 3.8 months (1-12) before presentation. The mean IOP was 27.6 ± 7.6 mmHg; two were on anti-glaucoma medications. Corneal infiltrates measured 3.4 ± 0.8 mm (horizontal) and 3.4 ± 1.4 mm (vertical). Three patients received additional topical voriconazole 1% (Vozole) and oral albendazole 400 mg daily for 1 month. Clinical resolution occurred in all cases after 9.4 ± 5.2 months of treatment, with no recurrence over a 12.6 ± 3.4-month follow-up.

Conclusion: The findings of this study support the potential of medical management for MSK, suggesting that topical fumagillin 0.007% may offer a viable treatment option for mild to moderate cases.