Indian Journal of Clinical and Experimental Ophthalmology 2023;9(1):45–48 Content available at: https://www.ipinnovative.com/open-access-journals Indian Journal of Clinical and Experimental Ophthalmology Journal homepage: www.ijceo.org Original Research Article Intrastromal and intracameral voriconazole combination: An adjuvant therapy in intractable mycotic keratitis Monika Dahiya 1, *, Mohit Dua 2 , Manisha Rathi 1 , Sumit Sachdeva 1 , Ruchi Dabas 1 1 Dept. of Ophthalmology, RIO, PGIMS, Rohtak, Haryana, India 2 Dept. of Sports Medicine, PGIMS, Rohtak, Haryana, India ARTICLE INFO Article history: Received 10-01-2023 Accepted 23-02-2023 Available online 30-03-2023 Keywords: Fungal keratitis Intractable infection Voriconazole ABSTRACT Aim: To study role of intrastromal and intracameral voriconazole combination in recalcitrant fungal Keratitis. Materials and Methods: 20 cases of recalcitrant fungal keratitis involving >50% stromal thickness and not showing good response to oral fluconazole, topical natamycin (5%) and topical voriconazole (1%) eye drops after 4 weeks of treatment were included in the study after taking informed written consent. Patients with impending or frank perforation, scleral involvement and endophthalmitis were excluded from the study. 30 min before the procedure, patient was given Tab acetazolamide 250mg stat to lower the intraocular pressure (IOP). Then under all aseptic conditions, 50 microgram/0.1 ml dose of intrastromal and intracameral voriconazole was given with 30G needle. Cases were examined daily for 1 week and then every week for 4 weeks for monitoring progression of fungal keratitis. Results: Out of 20 cases, 18 (90%) patients showed significant improvement after 4 weeks. Depending on the response after 1 week, patients were planned for repeat injection and only 1 patient required >3 injections in whom Lasiodiplodia theobromae was the causative organism. Only 1 patient got worsened and was ultimately managed with therapeutic keratoplasty. Conclusion: Intrastromal and intracameral voriconazole combination is an easy procedure with short learning curve which is highly efficacious and cost effective in recalcitrant fungal keratitis. This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. For reprints contact: reprint@ipinnovative.com 1. Introduction Microbial keratitis possesses a myriad clinical challenge for ophthalmologists due to its overlapping symptoms, variable presentation, rapid progression, diagnostic difficulty and potential complications leading to significant ocular morbidity. Fungal corneal ulcer is a common yet tenacious infection causing vision loss in young productive population of country leading to socioeconomic burden. Depending on the geographic location, mycotic or fungal keratitis, is responsible for almost 1-44% cases of microbial keratitis. 1 There is an uphill trend noticed in fungal keratitis * Corresponding author. E-mail address: drmonika2410@gmail.com (M. Dahiya). cases secondary to increase in contact lens usage, non- judiciary use of corticosteroids, vegetative trauma and diabetes mellitus. In developing countries, ocular trauma by vegetative material and objects contaminated with sand particles are the most common causes of fungal keratitis while contact lens (CL) use is the leading cause in developed countries. 2–4 The contact lens associated microbial keratitis is secondary to higher chance of adherence to cornea, wearing lens during sleep, smoking history and unhygienic contact lens behaviour. In addition to CL wear and vegetative trauma, ocular surface disease (OSD) is the third leading cause accounting for almost 29% of cases. 5,6 https://doi.org/10.18231/j.ijceo.2023.009 2395-1443/© 2023 Innovative Publication, All rights reserved. 45