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Subconjunctival administration of fluconazole is an effective method for the treatment of severe keratitis of fungal etiology

The aim of a prospective clinical study conducted on the basis of ophthalmic services at a hospital in Izmir (Turkey) was to assess the efficacy and safety of the subconjunctival administration of fluconazole as an alternative treatment for keratitis severe fungal resistant to traditional antifungal treatment.

The study included 13 patients with unilateral keratitis of fungal etiology. The average age of the patients was 49.6 years (28 to 75 years). Patients were diagnosed with severe fungal keratitis, resistant to fluconazole therapy (topically and intravenously) in combination with the administration of itraconazole indoors.

All patients underwent subconjunctival injections of a 2% solution of fluconazole at a dose of up to 1.0 ml twice a day for at least 5 days. At the end of a five-day treatment, if necessary, the treatment has been extended for a period of one to 14 days.

Six out of 13 patients reported healing after 5 days of subconjunctival injections of fluconazole. After seven days of treatment, seven patients received repeated injections of the drug. In one patient, despite therapy, he had to perform ocular evisceration - a surgical operation to remove the contents of the eyeball while preserving the sclera and the muscles attached to it.

The visual acuity index determined at the end of treatment depended on the location of the residual scar; in four cases, a corneal transplant was necessary. No local or systemic toxic side effects related to treatment with fluconazole have been reported.

Thus, the data obtained indicate that subconjunctival injections of fuconazole may be effective in the treatment of severe fungal keratitis and should help avoid surgical intervention in the acute stage of this process. In this study, a single dose of fluconazole was used and the different dosing schedules for this drug were not compared. Researchers believe that more studies are needed to assess the effectiveness of higher doses of fluconazole for subconjunctival keratitis injections that are resistant to repeated injections of a regular dose of fluconazole.