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Continuous voriconazole lavage in managing moderate and severe fungal keratitis: a randomized controlled trial

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To assess the effectiveness and safety of continuous lavage with 1% voriconazole (CL) for moderate and severe fungal keratitis.


Thirty-one patients were randomized to receive topical eye drops either alone (T) or combined with continuous 1% voriconazole lavage (CL-T). The primary outcome was the cure rate at 3 months. The secondary outcomes were the 6-day efficacy, 3-day infiltration size and depth, hypopyon height, central corneal thickness (CCT), epithelial defect size, and subject feelings and clinical signs assessment scores.


At 3 months, the cure rate was comparable between the groups in patients with moderate fungal keratitis (66.7% vs. 62.5%, P = 0.60). However, among severe cases, 4 cases (44.4%) in the CL-T group healed successfully, while none in the T group; this difference was not significant (P = 0.08), although it was very close to 0.05. This may be related to the small sample size. After 6 days, the percentage of patients with “worsened” ulcers in the CL-T group was lower than that in the T group (0% vs. 31%, P = 0.043). The infiltration size, infiltration depth, and hypopyon height in the CL-T group were smaller than those in the T group after 3 days (all P < 0.05). There was no difference in CCT, epithelial defect size, subject feelings scores, or clinical signs scores between groups.


These outcomes suggest that CL is an effective and safe adjuvant method for controlling the progression of moderate and severe fungal keratitis.

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The authors are grateful for the support from the National Natural Science Foundation of China.


This research was supported by the National Natural Science Foundation of China (nos. 82171030 and 81870678) and Natural Science Foundation of Hunan Province (no. 2021JJ30925).

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Correspondence to Baihua Chen.

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Ethical approval was obtained from the research ethics committees of the Second Xiangya Hospital of Central South University. All procedures followed and the data collected in this study were in accordance with the principles of the Declaration of Helsinki.

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Gong, Y., Zhang, L., Liu, S. et al. Continuous voriconazole lavage in managing moderate and severe fungal keratitis: a randomized controlled trial. Graefes Arch Clin Exp Ophthalmol 261, 1639–1649 (2023).

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