Comparison of Topical Itraconazole 1% versus Topical Fluconazole for the Treatment of Fungal Keratitis

This study was performed in Ophthalmology Department, Zagazig University including 40 eyes of 40 patients manifested clinically by fungal keratitis on the basic clinical criteria suggesting for fungal keratitis. The patients divided into two groups each had 20 patients. All patients submitted to full ophthalmological examination (Visual acuity - Slit lamp -Intraocular pressure -fluorescein staining of cornea -Fundus examination -Ocular ultrasonography for ulcers that masking the fundus examination)., systemic examination (Blood glucose level, liver function tests, kidney function tests, complete blood picture) and Laboratory studies (Corneal specimens were subjected to direct corneal smear by gram staining and culture for fugal organisms using Saboraud dextrose agar).Eyes with similar clinical and laboratory finding were classified into 2 groups of treatment.The study reported that the post treatment visual acuity in group one was, two patients had a minimal improvement, 8 patients gained one line,5 patients gained two lines and 5 patients gained three lines and in group (2), three patients had a minimal improvement, 9 patients gained one line,5 patients gained two lines and 3 patients gained three lines.In group (1) of treatment by topical itraconazole therapy including 20 eyes the study revealed statistically significant result ( P < 0.05) of healing of corneal ulcers in 17 eyes (85 %) including 16 cases of positive culture results and one case of negative results, one cases developed corneal perforation, one case developed endophthalmitis and one case developed penetrating keratoplasty. Also, the study showed statistically significant result (P < 0.05) in the mean duration of healing 30 days (SD ± 3.1).In group (2) of treatment by topical fluconazole the study revealed healing of corneal ulcers in 16 eyes (80%) including 15 eyes with a positive culture results and one eye with the negative culture result, the remaining 4 positive culture resistant eyes were Candida albicans, 2 eyes developed corneal perforation, 2 eyes turned to another fungal and bacterial treatment (one case developed endophthalmitis and one case developed penetrating keratoplasty). The mean duration of healing 34 days (SD ± 2.2).