Role of voriconazole in combined acanthamoeba and fungal corneal ulcer.

We report a case of a 21 year old male who presented with smear-proven fungal corneal ulcer in left eye, refractory to treatment with topical natamycin. Corneal smears and culture were taken along with anterior chamber tap for microbiological investigations and intracameral 1% voriconazole was injected followed by institution of oral as well as topical voriconazole drops. Corneal and aqueous smear as well as culture confirmed the presence of acanthamoeba. The keratitis responded favourably to voriconazole therapy which was instituted along with topical trophicidal drugs and anterior chamber became quiet by 7th day. The patient was slowly tapered from voriconazole and was off the drug by 6 months. At one year follow up, he continues to remain asymptomatic. The possibility exists that the fungal organisms had either partially or completely responded to natamycin eye drops and voriconazole therapy further inhibited their growth along with being highly efficacious in suppressing acanthamoeba trophozoites. Voriconazole may be specifically instrumental in corneal ulcers with coinfection of acanthamoeba and fungal organisms and preventing recrudescence of both. Normal saline wet mount and 10% KOH mount of paracentesis sample for suspicious cases of refractory corneal ulcers to specifically look for trophozoites in order to institute timely treatment are recommended.