Supradescemetic voriconazole injection for Candida parapsilosis keratitis.
Details
Serval ID
serval:BIB_F1B5888C3B3F
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Supradescemetic voriconazole injection for Candida parapsilosis keratitis.
Journal
International ophthalmology
ISSN
1573-2630 (Electronic)
ISSN-L
0165-5701
Publication state
Published
Issued date
04/2018
Peer-reviewed
Oui
Volume
38
Number
2
Pages
849-854
Language
english
Notes
Publication types: Case Reports ; Journal Article
Publication Status: ppublish
Publication Status: ppublish
Abstract
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.
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).
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.
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.
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).
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.
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.
Keywords
Aged, 80 and over, Antifungal Agents/administration & dosage, Candida parapsilosis/isolation & purification, Eye Infections, Fungal/drug therapy, Eye Infections, Fungal/microbiology, Humans, Injections, Intraocular, Keratitis/drug therapy, Keratitis/microbiology, Male, Treatment Outcome, Voriconazole/administration & dosage, Candida parapsilosis, Intracorneal injection, Keratitis, Supradescemetic injection, Voriconazole
Pubmed
Web of science
Create date
01/10/2019 12:22
Last modification date
06/10/2019 5:26