Successful Treatment of Microsporidial Keratoconjunctivitis (MKC) With a Combination of Topical Voriconazole 1% and Gatifloxacin 0.5%: A Large Case Series of 29 Patients

Balamurugan Ramatchandirane; Mohan Kumar A; Yamini Marimuthu; Deepthi Slesser Nicodemus; Mano Chandrika Yarra

doi:10.7759/cureus.49247

Successful Treatment of Microsporidial Keratoconjunctivitis (MKC) With a Combination of Topical Voriconazole 1% and Gatifloxacin 0.5%: A Large Case Series of 29 Patients

Cureus. 2023 Nov 22;15(11):e49247. doi: 10.7759/cureus.49247. eCollection 2023 Nov.

Authors

Balamurugan Ramatchandirane¹, Mohan Kumar A², Yamini Marimuthu³, Deepthi Slesser Nicodemus¹, Mano Chandrika Yarra²

Affiliations

¹ Ophthalmology, All India Institute of Medical Sciences (AIIMS), Mangalagiri, IND.
² Medical Microbiology, All India Institute of Medical Sciences (AIIMS), Mangalagiri, IND.
³ Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Mangalagiri, IND.

Abstract

Objective: This study aims to report the successful treatment of microsporidial keratoconjunctivitis (MKC) with the combination of topical drops of voriconazole (1%) and gatifloxacin (0.5%) in all 29 patients. Demography, clinical profile, and previous treatment history were also analyzed.

Methods: A retrospective, non-comparative case series of all Gram stain-proven MKC from September 2021 to October 2022 was included in this study. Patients were given antimicrobials such as topical drops of voriconazole 1%, gatifloxacin 0.5%, or a combination of both in 29 patients based on the treatment response. Topical steroids were added to 31 patients for corneal haziness.

Results: A total of 33 patients were found to be positive for microsporidiosis confirmed by Gram staining. Twenty-four (72.7%) were men and nine (27.3%) were women. The mean age was 34.45±12. The presenting symptoms were mainly redness in 30 patients (90.9%), followed by watering in 13 (39.4%), foreign body sensation in 10 (30.3%), etc. Among the 23 patients (69%), a history of risk factors was identified, with 17 patients (51.5%) specifically reporting dust exposure as a major cause. MKCs were successfully treated with antimicrobials such as voriconazole 1% in three patients, gatifloxacin 0.5% in one patient, and a combination of both in 29 patients. Topical steroids were added to 31 patients for corneal haziness. At the last follow-up, a visually insignificant nummular corneal scar was noted in six patients. No drop in vision was noted in any of these patients at the end of the follow-up. No cases progressed to stromal keratitis and no surgical intervention was required in any cases.

Conclusions: We successfully treated all 29 cases with a combination of voriconazole and gatifloxacin without requiring any surgical intervention or encountering stromal complications. This successful treatment in all 29 cases offers valuable insights into the potential of this drug combination, possibly attributable to its additive action or broad-spectrum coverage across various species.

Keywords: combination of voriconazole and gatifloxacin; empirical treatment; gatifloxacin; keratitis; microsporidial keratoconjunctivitis; microsporidiosis; mixing and mashing technique; mkc; scraping technique; voriconazole.