Efficacy of intracameral amphotericin B injection in the management of refractory keratomycosis and endophthalmitis.

PURPOSE: To evaluate the efficacy of intracameral amphotericin B injection in the adjunctive management of keratomycosis with probable intraocular extension not responding to conventional antifungal therapy.

METHODS

Fourteen eyes of 12 patients with fungal keratitis that did not respond to initial treatment with topical and intravenous fluconazole and oral itraconazole were treated with up to 5 intracameral injections of 5 microg of amphotericin B. Six eyes received one injection, and 8 required subsequent injections.

RESULTS

Twelve eyes responded to amphotericin B therapy, including 5 that healed with a central corneal scar and 8 that healed with a peripheral opacity. Two eyes progressed to evisceration. Four eyes developed anterior subcapsular cataract after intracameral amphotericin B.

CONCLUSIONS

Intracameral amphotericin B may be an effective adjunctive treatment of fungal keratitis unresponsive to conventional antifungal therapy, although cataract may occur.