Intrastromal Amphotericin B as a Treatment for Fungal Infectious Keratitis

Abstract

Fungal keratitis is a major cause of corneal blindness, especially in tropical and subtropical countries. The prognosis is poor compared to many other forms of keratitis due to the limited availability of effective medications. Available antifungals suffer from multiple drawbacks, such as poor ocular penetration, unpredictable bioavailability, and adverse effects associated with systemic medications. Intrastromal injection is a relatively new technique that allows the drug to be administered directly at the site of infection and has shown high success in the treatment of severe treatment-resistant infectious keratitis, especially when surgery is not recommended. In cases where the disease reaches the deep stroma, intrastromal injections may be necessary to achieve a higher drug concentration. Despite promising findings, further studies are still needed to confirm the safety and efficacy of this approach. Three patients diagnosed with fungal keratitis refractory to standard treatment are presented. Clinical improvement was achieved after the administration of two doses of intrastromal amphotericin B.