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UDC 617.713-002-02:616.992.28]-085.33+615.33

Rania A Abdullah1, M.S, Eman A Awad2, MD, Tarek A Mohsen2, MD, Tharwat H. Mokbel2, MD

1Ophthalmolgy hospital, Mansoura, Egypt
2Ophthalmology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt

Abstract. Fungal keratitis is a sight threatening condition which is widespread in tropical and subtropical countries. This study aimed to evaluate the efficacy of a combination of topical and intracameral injections of amphotericin B in the treatment of severe fungal keratitis.
Patients and methods. This prospective, comparative study included 40 patients of culture proved fungal keratitis recruited from outpatient clinic of Mansoura ophthalmic center, faculty of medicine Mansoura University, Egypt, in the period from January 2017 to December 2018. Pregnant and lactating women, Children < 12 years of age, One-eyed patients, Patients with concurrent sclera involvement and Patients with impending perforations, elevated intraocular pressure were excluded from the study. The patients were randomly divided into 2 groups: Group A: underwent only topical amphotericin B. Group B: underwent combined topical & intracameral injection of antimicrobials. Patients were followed up at 1 day, 1 week, weekly till the end of the first month after injection then every 2 weeks for another month after then monthly till the 6th month.
Results. Both groups were sex and age matched. Trauma was the most common risk factor recorded. Aspergillus was the commonest causative agent (85%) in group A, the size of corneal ulcer improved from 32.44 ± 19.37 to 29.71 ± 17.16 at 1st week to 18.81 ± 10.04 in the 1st month, in group B the ulcer size decreased from 30.24 ± 16.09 to 21.81 ± 11.04 (p<0.001) in the 1st week the ulcer achieved complete healing within 3 months. In group A the hypopyon level was 2.46 ± 1.23 mm which was fixed at the same value at 2nd day then decreased to 1.36 ± 0.43 ml at 1st month then to 0.90 ± 0.31 mm and 0.37 ± 0.17 mm at 2nd and 3rd months. In group B, the base line of hypopyon level was 3.22 ± 2.09 mm decreased to 1.45 ± 0.62 mm (at 1st week) decreased from 1.02 ± 0.61 mm at 2nd weeks to 0.33 ± 0.19 mm at 6th weeks. In group A, the reported complications were staphyloma (2 cases), thinning (6 cases), hyphema (2 cases) and Atrophia Bulbi (1 case). In group B the complications showed mild variations in distribution as follows; staphyloma (1 case), thinning (3 cases), hyphema (3 cases) and Atrophia Bulbi (1 case). The mean duration for the complete healing in group A, was 48.82 ± 5.31 days while the mean duration in group B, that was 29.59 ± 3.24 days (p< 0.001).
Conclusions. Intracameral Amphotericin B injection is safe and effective technique in treatment of fungal keratitis.

Keywords: cornea, keratitis, intracamеral injection, Amphotericin.