Adjunctive topical versus intrastromal voriconazole in mycotic keratitis

Evaluation of: Sharma N, Chacko J, Velpandian T et al. Comparative evaluation of topical versus intrastromal voriconazole as an adjunct to natamycin in recalcitrant fungal keratitis. Ophthalmology 120(4), 677–681 (2013).Topical natamycin is generally considered first-line treatment for mycotic keratitis. The authors of the paper being evaluated have reported earlier that intrastromal voriconazole is effective therapy for recalcitrant deep mycotic keratitis. The paper being evaluated extends those observations, while emphasizing that voriconazole is probably best considered as an adjunct to natamycin in recalcitrant mycotic keratitis; moreover, intrastromal injections were not obviously more beneficial than topical therapy. The ulcers receiving intrastromal voriconazole were possibly more severe than those in the topical voriconazole treatment group if mean sizes of epithelial defect and stromal infiltrate and presence of hypopyon are considered. Studies on additional patients may elucidate differences that were not apparent due to the relatively small number of patients treated.