Role of aprotinin in the management of experimental fungal keratitis

In an experimentally induced Aspergillus fumigatus fungal keratitis in 20 r abbits, aprotinin, an antiplasmin agent, was studied to find out its role a s an adjuvant when given along with other established antifungal agents lik e natamycin and fluconazole. The 20 rabbits included in this study were ran domly divided into four equal treatment groups. Once the ulcer was produced after intrastromal injection of 0.03 mi of A. fumigatus (5.5 x 10(4) spore s/ml), different drugs/agents in combination were used in a randomized mann er. These were natamycin (5%) + placebo, natamycin + aprotinin (40 IU/ml), fluconazole (0.3%) + placebo and fluconazole + aprotinin. The rabbits were followed up every day to note the signs of healing which included subsidenc e of corneal infiltration, disappearance of stromal abscess and subsidence of corneal oedema till complete healing. Results showed that the average he aling time was 28.2, 28.4, 49.8 and 49.0 days for natamycin + placebo, nata mycin + aprotinin, fluconazole + placebo and fluconazole + aprotinin, respe ctively. It suggests that aprotinin as an adjuvant has no definite role in the management of fungal keratitis. The plasminogen activator-plasmin syste m which is inhibited by aprotinin may not be the pathway through which fila mentous fungi like A. fumigatus cause tissue destruction. Copyright (C) 200 1 S. Karger AG, Basel.