Supradescemetic voriconazole injection for Candida parapsilosis keratitis.

Authors:
Dr. Nikolaos Mamas, MD, PhD, FEBOphth
Dr. Nikolaos Mamas, MD, PhD, FEBOphth
Moorfields Eye Hospital
Medical Retina Fellow
London | United Kingdom
Konstantinos Andreanos
Konstantinos Andreanos
"G. Gennimatas" General Hospital of Athens
Greece
Klio Chatzistefanou
Klio Chatzistefanou
University of Athens Medical School
Greece
Petros Petrou
Petros Petrou
Moorfields Eye Hospital
United Kingdom
Dimitrios Brouzas
Dimitrios Brouzas
University of Athens
George Kymionis
George Kymionis
Institute of Vision and Optics
Chrysanthi Koutsandrea
Chrysanthi Koutsandrea
University of Athens
Greece
Konstantinos Droutsas
Konstantinos Droutsas
Philipps University

Int Ophthalmol 2018 Apr 18;38(2):849-854. Epub 2017 Apr 18.

First Department of Ophthalmology, National and Kapodistrian University of Athens, Mesogeion Ave 154, 156 67, Athens, Greece.

Purpose: To describe a technique for intracorneal application of voriconazole into the supradescemetic space in a case of deep recalcitrant Candida parapsilosis keratitis of a penetrating cornea graft.

Methods: A deep intracorneal incision reaching the center of the corneal infiltrate was created with a 20-gauge MVR blade. Then, a 27-gauge hydrodissection cannula was inserted deep into the corneal pocket, and 0.1 ml of voriconazole 0.5 mg/ml was injected until a bullous detachment of Descemet membrane (DM) covered 1/3 of the graft's area. DM detachment was documented by anterior segment optical coherence tomography (AS-OCT).

Results: AS-OCT confirmed the creation of a drug depot in the supradescemetic space, which partially regressed during the following hours; 24 h after the injection, a complete reattachment of DM was documented. After 4 weeks, the stromal infiltrate has cleared completely and no signs of recurrence were observed 3 months after injection.

Conclusion: In the present case, the supradescemetic voriconazole injection led to resolution of a deep recalcitrant fungal infiltrate. The herein described technique could be tried in similar cases, where an intrastromal injection is indicated, as it may offer a larger intracorneal drug depot.

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April 2018
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