Intracameral amphotericin B - Initial experience in severe keratomycosis

Purpose. Fungal keratitis is a significant cause of ocular morbidity in Ind ia. The most commonly implicated fungi are Aspergillus spp. Patients often present with hypopyon, which usually contains fungal elements. The treatmen t is difficult owing to poor intraocular penetration of most available anti fungal agents. This study evaluated the results of intracameral injection o f amphotericin B in natamycin resistant cases of severe keratomycosis. Meth ods. Three patients of culture proven Aspergillus flavus corneal ulcer with hypopyon not responding to topical natamycin 5%, amphotericin B 0.15%, and oral itraconazole were administered intracameral amphotericin B. The first case received 7.5 mug in 0.1 mL followed by two subsequent injections of 1 0 mug in 0.1 mL each, the second case received two injections of 10 mug in 0.1 mL, and the third patient received a single dose of 10 mug in 0.1 mL. C ulture of the aqueous sample also grew A. flavus in all three cases. Result s. All three cases responded favorably, with the ulcer and hypopyon clearin g completely. There was no clinical evidence of corneal or lenticular toxic ity in any patient. Conclusions. Intracameral amphotericin B may be a usefu l modality in the treatment of severe keratomycosis not responding to topic al natamycin. It ensures adequate drug delivery into the anterior chamber a nd may be especially useful to avoid surgical intervention in the acute sta ge of the disease.