Topical Amphotericin B and Subconjunctival Injection of Fluconazole (Combination Therapy) Versus Topical Amphotericin B (Monotherapy) in Treatment of Keratomycosis

Purpose: The aim of the study was to compare the use of combination therapy of topical amphotericin B (0.5 mg/mL) eye drops together with subconjunctival injection of fluconazole (2 mg/mL) with the use of topical amphotericin B (0.5 mg/mL) eye drops alone in dealing with cases of fungal keratitis. Methods: The study was performed in the Ophthalmology Department, Zagazig University and included 48 eyes of 48 patients who presented clinically with fungal keratitis. Laboratory investigations were performed, including direct microscopy of corneal smear using gram staining and culture of corneal specimens using Saboraud agar media and bacterial agar media. According to laboratory results, cases were classified into 2 groups: group 1 comprising 24 eyes treated by a combination therapy of topical amphotericin B eye drops (0.5 mg/mL) with subconjunctival injection of fluconazole (2 mg/mL) and group 2 comprising 24 eyes treated by topical amphotericin B eye drops (0.5 mg/mL) alone. Results: Direct corneal smear for all 48 eyes included in the study revealed 18 eyes (38\%) with positive fungal spores, 3 of them (6\%) with gram-positive bacterial infection. Fungal culture of corneal specimens revealed positive result in 36 eyes (75\%), including the positive corneal smear cases showing Candida in 12 eyes and filamentous fungi in 24 eyes. Treatment by a combination therapy in group 1 revealed statistically significant result (P < 0.05) of healing of corneal ulcers in 20 eyes (83\%), with a mean duration of healing of 31 days (standard deviation {[}SD] +/- 3), in comparison to group 2 with monotherapy, which revealed 16 eyes (67\%), with a mean duration of healing of 37 days (SD +/- 2). Conclusion: Combination therapy of topical amphotericin B eye drops with subconjunctival injection of fluconazole was more efficient (according to the percentage and the duration of healing of the ulcers) than the use of topical amphotericin B eye drops alone in dealing with cases of fungal keratitis-it may be contributed to the broad spectrum of the antifungal agents of the combination therapy than the monotherapy.