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Evaluation of Intra-corneal Injection of 5% Natamycin for the Treatment of Fusarium Keratitis

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

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Evaluation of Intra-corneal Injection of 5% Natamycin for the Treatment of Fusarium Keratitis

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  1. Evaluation of Intra-corneal Injection of 5% Natamycin for the Treatment of FusariumKeratitis FaniSegev MD, Guy Tam MD, YossiPaitan PhD, DvoraKidron MD Department of Ophthalmology, Microbiology & Pathology, Meir General Hospital, Kfar-Saba, Sackler School of Medicine, Tel Aviv University, Israel

  2. DISCLOSURES • The authors have no financial interest in the subject matter of this poster

  3. 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.

  4. 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 Fusariumkeratitis.

  5. METHODS • A prospective randomized case control study • Keratitiswas 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

  6. METHODS – CONT. • Rabbits were randomly divided into two groups: • Group 1: received intra-stromal injection of Natamycin5% 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

  7. RESULTS • Fusariumkeratitis 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). • Neovascularizationwas statistically smaller in the control group (P=0.032).

  8. Clinical Scores during Follow-Up

  9. Clinical Course by Day

  10. Clinical Course GROUP 1 GROUP 2

  11. CONCLUSIONS • Intra-stromal injection of Natamycin 5% combined with topical Natamycin 5% is an effective treatment modality for Fusariumkeratitis.

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