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. 2023 Mar 29;15(4):1091. doi: 10.3390/pharmaceutics15041091

Table 1.

Outcomes of intrastromal injections in the management of mycotic keratitis.

Author Year Intervention Indication n Healing Rate Main Cultures Mean Healing Duration Special Comments
Prakash et al. [37] 2008 IS VCZ as an adjuvant to topical NTM and VCZ Deep recalcitrant fungal keratitis 3 100% Fusarium spp. and Aspergillus 18.6 ± 4 days Targeted delivery of VCZ is safe and effective
Tu [45] 2009 IS VCZ with topical capsofungin or topical fluconazole Alternaria keratitis not responding to standard therapy 3 100% Alternaria 1 case needed IS VCZ with topical capsofungin
Sharma et al. [40] 2011 IS VCZ after topical NTM, VCZ and oral VCZ Recalcitrant fungal keratitis 12 83% healed, all of them received >1 injection Aspergillus and Fusarium 39.7567.62 days IS VCZ is effective in recalcitrant fungal keratitis
Sharma et al. [38] 2013 Topical vs. IS VCZ as an adjuvant to topical NTM Recalcitrant fungal keratitis 40 95% in topical VCZ vs. 80% in IS VCZ (p = 0.34) Aspergillus (30%), Fusarium (17.5%) 28.9 ± 19.1 days in topical VCZ vs. 36.1 ± 20.2 days in IS VCZ IS injections with VCZ are not superior to topical VCZ
Tu and Hu et al. [43] 2014 IS VCZ and IS AMB Late-onset post-DSAEK interface fungal keratitis 2 100% Candida species 3 weeks IS antifungal therapy is useful in preserving graft viability.
Kalaiselvi et al. [42] 2015 IS VCZ after topical NTM and VCZ Deep recalcitrant fungal keratitis 25 72%, of which 4 patients needed >1 injection Fusarium (52%), Aspergillus (16%) 45.68 ± 11.49 days IS VCZ is safe and effective in treating deep recalcitrant fungal keratitis
Nada et al. [48] 2017 IS AMB and topical FCZ (group A) vs. topical AMB (group B) Fungal keratitis 68
  • -

    82.9% in combined therapy

  • -

    59.3% in topical AMB

 Candida and Aspergillus 24 ± 6.42 days vs. 39.66 ± 13.6 days
Konar et al. [41] 2019 IS VCZ after topical NTM and VCZ Recalcitrant mycotic keratitis 20 70% healed and 15 patients required more than 1 injection (between 2 and 7 injections) Fusarium (30%) 35.5 ± 9.22 days IS VCZ is proven to be safe in recalcitrant mycotic keratitis
Narayana et al. [39] 2019 IS VCZ + topical NTM vs. topical NTM alone Primary treatment of severe filamentous fungal ulcers 70
  • -

    77% in IS VCZ and topical NTM

  • -

    91% in topical NTM alone

 Fusarium (27%), Aspergillus (24%) IS VCZ shows no benefit as an adjuvant to NTM in primary treatment
Saluja et al. [55] 2021 IS NTM after 2 weeks of topical NTM Recalcitrant fungal keratitis 20 95% healed and 30% needed >1 injection Aspergillus (60%) and Fusarium (40%) 35.3 ± 6.4 days IS of novel formulation of NTM plays a promising role in management of recalcitrant fungal keratitis
Saluja et al. [54] 2021 IS VCZ vs. IS AMB vs. IS NTM after two weeks of topical NTM Recalcitrant fungal keratitis 60
  • -

    95% in IS VCZ group

  • -

    90% in IS AMB group

  • -

    95% in IS NTM group

 Aspergillus (53%) and Fusarium (40%)
  • -

    34 ± 5.2 days in IS NTM group

  • -

    36.1 ± 4.8 days in IS VCZ group

  • -

    39.2 ± 7.2 days in IS AMB group

 All three antifungal agents show good therapeutic response in recalcitrant fungal keratitis

n, number of cases; IS, intrastromal; VCZ, voriconazole; NTM, natamycin; AMB, amphotericin B; DSAEK, Descemet Stripping Automated Endothelial Keratoplasty.

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