EVALUATION OF INTRA-CORNEAL INJECTION OF 5% NATAMYCIN FOR

THE TREATMENT OF FUSARIUM KERATITIS

Fani Segev MD, Guy Tam MD, Yossi Paitan PhD, Dvora Kidron MD

Department of Ophthalmology, Microbiology & Pathology, Meir General Hospital, Kfar-Saba,

Sackler School of Medicine, Tel Aviv University, Israel

DISCLOSURES

The authors have no financial interest in the subject matter of this poster

INTRODUCTION

Fungal keratitis represents a serious ophthalmic infection.

If untreated, it can lead to serious complications such as endophthalmitis, perforation and blindness.

Globally, the incidence of fungal keratitis is rising due to: Use of topical steroids Use of long -term contact lenses Increase in surgical corneal procedures

Filamentous fungi (Fusarium and Asppergillus) form the major etiologic agents of fungal keratitis.

Fungal keratitis is treated with topical antifungal agents and in severe cases with combination of oral antifungal agent.

Most of the medications have limited effectiveness, absorbs poorly, and have low potency.

OBJECTIVE

To compare the efficacy of intra-stromal

injection of Natamycin 5% combined with

topical Natamycin 5% to a standard

therapy (Natamycin 5%) in a rabbit model

of Fusarium keratitis.

METHODS

A prospective randomized case control study

Keratitis was induced in eyes of 12 NZ rabbits by intra-stromal injection of 1.6x105 CFU/0.1ml of Fusarium spore suspension into the central cornea

METHODS – CONT.

Rabbits were randomly divided into two groups: Group 1: received intra-stromal injection of Natamycin 5% on treatment day 1

and 4 combined with topical Natamycin 5% eye-drops given hourly for the first 2 days followed by 4 times daily on days 3-11.

Group 2: received only topical Natamycin 5% at identical interval.

Eyes were examined clinically on treatment days 1,4,7 and 11.

Extent of keratitis was graded by the following parameters: size of corneal infiltration and epithelial defect conjunctival hyperemia corneal clouding corneal neovascularization hypopion level

RESULTS

Fusarium keratitis with hypopion developed in all eyes 4 days after intra-stromal inoculation.

In both treatment groups, clinical improvement of keratitis was recorded.

Infiltration size was statistically smaller in the intra-stromal injected group (P=0.023).

Neovascularization was statistically smaller in the control group (P=0.032).

Clinical Scores during Follow-Up

Clinical Course by Day

Clinical Course

GROUP 1 GROUP 2

CONCLUSIONS

Intra-stromal injection of Natamycin 5% combined with topical Natamycin 5% is an effective treatment modality for Fusarium keratitis.