Topical and oral voriconazole in the treatment of fungal keratitis

PURPOSE: To describe nine patients with fungal keratitis refractory to standard antifungal therapy whose condition was managed with voriconazole. DESIGN: Retrospective case series. METHODS: Chart review of patients with fungal keratitis who were treated with topical and oral voriconazole. RESULTS: Nine patients were treated. Two patients were contact lens wearers who used multipurpose cleaning solutions. Corneal isolates found were Fusarium (three patients), Candida albicans (three patients), Alternaria (one patient), Scopulariopsis (one patient), and Scedosporium apicispermum (one patient). Nine patients were treated with topical voriconazole, and eight patients were treated with oral voriconazole. Patients were treated topically for four to 16 weeks (mean, 10 weeks) and orally for five to 17 weeks (mean, 10 weeks). One patient was lost to follow-up. Two patients discontinued the topical voriconazole after one day and four weeks, respectively, because of ocular burning. Of the seven patients who were treated with topical therapy and followed, five conditions healed. CONCLUSION: Voriconazole is a new, promising therapy for fungal keratitis that is refractory to standard antifungal treatments.