A Combination of Intrastromal and Intracameral Injections of Amphotericin B in the Treatment of Severe Fungal Keratitis

Abstract

Purpose. To evaluate the efficacy of a combination of intrastromal and intracameral injections of amphotericin B in the treatment of severe recalcitrant fungal keratitis. Methods. Patients with severe fungal keratitis who were resistant to conventional antifungal medical treatments and needed potential surgical intervention were recruited at the First Affiliated Hospital of Fujian Medical University between January 2012 and July 2013. The patients were treated with a combination of intrastromal and intracameral injections of amphotericin B (25 μg/mL and 50 μg/mL, resp.). Selectively repeated injections were performed as necessary. The efficacy, complications, and outcome were evaluated. Results. Nine patients (9 eyes) were involved in this study. All 9 cases responded favorably, and the clinical appearance of serious corneal damage and intraocular extension was resolved after the treatment. Four eyes required only 1 injection, and 5 eyes required repeated injections. Seven corneal ulcers healed with leucoma, and 2 healed with adherent leucoma. All of our cases had a marked increase in the anterior chamber reaction and pain immediately after the injection. There was no obvious clinical evidence of corneal or lenticular toxicity in any patient. Conclusions. A combination of intrastromal and intracameral injections of amphotericin B may be safe and effective for the treatment of severe fungal keratitis that is resistant to conventional therapy.