Continuous administration of voriconazole enhances therapeutic effect for recalcitrant fungal keratitis

Weiyan Liang, Chang Liu, Xiansen Zhang, Ling Li, Zexia Dou, Dandan Li, Xinxin Li, Bowen Wu, Mingwu Wang, Shaowei Li

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Purpose: To evaluate the therapeutic effect of incorporating continuous administration of voriconazole in the treatment of recalcitrant fungal keratitis. Methods: In this prospective case study, 5 consecutive patients (5 eyes) with fungal keratitis were treated with a standard protocol after the failing maximal conventional medical treatment. The protocol involved continuous lavage of the ulcer with 1% voriconazole through an irrigator for 2 h, twice a day, combined with local and systemic antifungals. Visual acuity, slit lamp findings of the ulcer, and fungal hyphae density by confocal microscope were documented, respectively. Results: In 4 patients, the clinical symptoms and slit lamp examination were significantly improved after only 3 days of treatment. The hyphae were shown to decrease in number and morphologically fragmented in corneal stroma by confocal microscopy. After the infection was controlled, 2 cases required further keratoplasty. In one case, the treatment was deemed ineffective and a conjunctival flap had to be created to help control the infection. In all 5 patients, the best spectacle-corrected visual acuity had improved after treatment. With more than 3 months of follow-up, no recurrence of infection was seen in any cases. Conclusion: Our treatment protocol demonstrated improvement in the treatment of clinically resistant fungal keratitis. Continuous lavage of voriconazole is easy to be implemented and well-tolerated by patients. Modification of the current protocol should be further explored to optimize the therapeutic effectiveness in future.

Original languageEnglish (US)
Pages (from-to)2688-2694
Number of pages7
JournalEuropean Journal of Ophthalmology
Issue number5
StatePublished - Sep 2022


  • confocal microscopy
  • continuous lavage
  • fungal keratitis
  • voriconazole

ASJC Scopus subject areas

  • Ophthalmology


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