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Clinical results of topical fluconazole for the treatment of filamentous fungal keratitis

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Abstract

Background

Fungal keratitis is a rare but serious condition that may result in loss of vision. The potentially poor prognosis might be due to a delay in diagnosis and/or to limited treatment options. The aim of this study is to evaluate the clinical outcome of patients treated with topical fluconazole 0.2% for the treatment of filamentous fungal keratitis.

Methods

Retrospective case series. A chart review of all patients evaluated at the Ophthalmology Department of the Hospital de Clínicas in Paraguay from January 1997 to December 2000 identified 25 cases of fungal keratitis. Among these cases, one patient discontinued the treatment and another received amphotericin as the first line drug, resulting in 23 cases available for data analysis. Twelve patients were treated with topical fluconazole 0.2% alone (Group I) and 11 patients received a combination of topical fluconazole 0.2% and oral ketoconazole 200 mg twice daily (Group II).

Results

Sixteen of 23 cases showed resolution of the keratitis, 9/12 (75%) in Group I and 7/11 (64%) in Group II. Seven patients (30%) did not respond to medical treatment and required a surgical procedure to preserve eye integrity. Superficial and small ulcers have a significantly better prognosis than do lrge and deep ulcers. Concomitant oral ketoconazole (400 mg/day) did not improve the clinical results.

Conclusions

Our findings of study suggest that topical fluconazole 0.2% is a safe and effective antifungal drug for the management of filamentous mycotic keratitis, particularly in cases that are not severe. The addition of oral ketoconazole to topical fluconazole did not improve the clinical outcome.

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Acknowledgements

The authors thank the Georg and Hannelore Zimmermann Foundation, Munich, Germany and the Department of Ophthalmology at the Ludwig Maximilians University, Munich, Germany for financial and technical support of this study.

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Authors and Affiliations

  1. Department of Ophthalmology, Hospital de Clínicas, Universidad Nacional de Asunción, Asunción, Paraguay

    Sergio Sonego-Krone, Daniel Sanchez-Di Martino, Rosa Ayala-Lugo & Guillermo Torres-Alvariza

  2. Department of Ophthalmology, School of Medicine, Stanford University, Stanford, CA, USA

    Christopher N. Ta & Herminia Miño de Kaspar

  3. Department of Ophthalmology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil

    Luciene Barbosa

  4. Department of Ophthalmology, Ludwig Maximilians University, Munich, Germany

    Herminia Miño de Kaspar

  5. Mayor Fleitas 447 casi Cerro Corá, Asunción, Paraguay

    Sergio Sonego-Krone

Authors
  1. Sergio Sonego-Krone
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  2. Daniel Sanchez-Di Martino
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  3. Rosa Ayala-Lugo
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  4. Guillermo Torres-Alvariza
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  5. Christopher N. Ta
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  6. Luciene Barbosa
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  7. Herminia Miño de Kaspar
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Corresponding author

Correspondence to Sergio Sonego-Krone.

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None of the authors has any financial interest in the materials used on this study.

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Sonego-Krone, S., Sanchez-Di Martino, D., Ayala-Lugo, R. et al. Clinical results of topical fluconazole for the treatment of filamentous fungal keratitis. Graefe's Arch Clin Exp Ophthalmo 244, 782–787 (2006). https://doi.org/10.1007/s00417-005-1127-8

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  • DOI: https://doi.org/10.1007/s00417-005-1127-8

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