Management of tunnel fungal infection with voriconazole

J Cataract Refract Surg. 2007 May;33(5):915-7. doi: 10.1016/j.jcrs.2006.12.026.

Abstract

A 59-year-old woman presented 1 month after cataract surgery in the right eye with a stromal infiltrate at the site of the cataract surgery wound. The visual acuity was perception of light with accurate projection. Corneal scraping of the infiltrate revealed septate hyphae. There was no response to 6 weeks of therapy with topical fortified antibiotic agents and topical antifungal therapy in the form of natamycin 5%, amphotericin B 0.15%, and intracameral amphotericin B. The patient was started on oral voriconazole 200 mg twice daily and topical voriconazole 1% every hour, and resolution of the ulcer was noted within 3 days. At the 4-month follow-up, a visual acuity of 20/60 was achieved, with the formation of a vascularized corneal opacity superiorly. This case illustrates that topical and oral voriconazole may be used in the treatment of recalcitrant cases of fungal tunnel infections not responding to conventional antifungal therapy.

Publication types

  • Case Reports

MeSH terms

  • Administration, Oral
  • Administration, Topical
  • Aged
  • Antifungal Agents / therapeutic use*
  • Cataract Extraction
  • Corneal Ulcer / drug therapy*
  • Corneal Ulcer / microbiology
  • Eye Infections, Fungal / drug therapy*
  • Eye Infections, Fungal / microbiology
  • Female
  • Fusarium / isolation & purification*
  • Humans
  • Microsurgery
  • Mycoses / drug therapy*
  • Mycoses / microbiology
  • Pyrimidines / therapeutic use*
  • Surgical Wound Infection / drug therapy*
  • Surgical Wound Infection / microbiology
  • Triazoles / therapeutic use*
  • Visual Acuity
  • Voriconazole

Substances

  • Antifungal Agents
  • Pyrimidines
  • Triazoles
  • Voriconazole