Assessment safety and efficacy of a combination therapy of topical amphotericin B and subconjunctival fluconazole for the treatment of fungal keratitis

Purpose:The study was aimed at evaluating the treatment of fungal keratitis using a combination therapy of a low concentration of topical amphotericin B (0.2 mg/mL) eye drops together with subconjunctival injections of 2 mg/mL of fluconazole. Methods:The study was carried out in the Ophthalmology Department of Zagazig University Hospital and included 12 patients with 12 pairs of eyes with resistant corneal ulcers that had the following clinical features suggesting fungal keratitis: thick elevated ulcer, feathery edge, and gutter formation. Cultures of corneal specimens were grown on Sabouraud agar medium. Topical amphotericin B eye drops in a concentration of 0.2 mg/mL in dextrose 5\% were used every 2 hours for 21 days together with subconjunctival injections of fluconazole 2 mg/mL. Results: Among the eyes subjected to culture of corneal specimens, 8 eyes had positive results: Candida was detected in 5 eyes (66\%) and filamentous fungi grew from the cultures of 3 eyes. Nine eyes improved as a result of treatment, showing complete healing of the ulcers (75\%). Three cases showed no improvement (25\%); 2 cases developed endophthalmitis; and 1 case was negative. A single case with corneal perforation had negative results on culture. Conclusion: The use of a combination of topical amphotericin B eye drops at a concentration of 0.2 mg/mL in dextrose 5\% with subconjunctival injection of fluconazole 2 mg/mL had the advantage of a lower incidence of the complications of local use of amphotericin B and a broader spectrum of antifungal coverage. This study reports a relatively high success rate of healing of fungal keratitis, with a significant reduction of the potential side effects of the local use of antifungal agents.