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Gong Y, Zhang L, Liu S, Zhang H, Peng L, Li H, Dai S, Chen B. Continuous voriconazole lavage in managing moderate and severe fungal keratitis: a randomized controlled trial. Graefes Arch Clin Exp Ophthalmol 2023; 261:1639-1649. [PMID: 36642766 DOI: 10.1007/s00417-022-05969-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/30/2022] [Accepted: 12/28/2022] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To assess the effectiveness and safety of continuous lavage with 1% voriconazole (CL) for moderate and severe fungal keratitis. METHODS Thirty-one patients were randomized to receive topical eye drops either alone (T) or combined with continuous 1% voriconazole lavage (CL-T). The primary outcome was the cure rate at 3 months. The secondary outcomes were the 6-day efficacy, 3-day infiltration size and depth, hypopyon height, central corneal thickness (CCT), epithelial defect size, and subject feelings and clinical signs assessment scores. RESULTS At 3 months, the cure rate was comparable between the groups in patients with moderate fungal keratitis (66.7% vs. 62.5%, P = 0.60). However, among severe cases, 4 cases (44.4%) in the CL-T group healed successfully, while none in the T group; this difference was not significant (P = 0.08), although it was very close to 0.05. This may be related to the small sample size. After 6 days, the percentage of patients with "worsened" ulcers in the CL-T group was lower than that in the T group (0% vs. 31%, P = 0.043). The infiltration size, infiltration depth, and hypopyon height in the CL-T group were smaller than those in the T group after 3 days (all P < 0.05). There was no difference in CCT, epithelial defect size, subject feelings scores, or clinical signs scores between groups. CONCLUSION These outcomes suggest that CL is an effective and safe adjuvant method for controlling the progression of moderate and severe fungal keratitis. TRIAL REGISTRATION NUMBER ChiCTR2100050565.
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Affiliation(s)
- Yujia Gong
- Department of Ophthalmology, The Second Xiangya Hospital of Central South University, Changsha, 410011, China.,Hunan Clinical Research Center of Ophthalmic Disease, Changsha, 410011, China
| | - Liwei Zhang
- Department of Ophthalmology, The Second Xiangya Hospital of Central South University, Changsha, 410011, China.,Hunan Clinical Research Center of Ophthalmic Disease, Changsha, 410011, China
| | - Shaohua Liu
- Department of Ophthalmology, The Second Xiangya Hospital of Central South University, Changsha, 410011, China.,Hunan Clinical Research Center of Ophthalmic Disease, Changsha, 410011, China
| | - Hongyan Zhang
- Department of Ophthalmology, The Second Xiangya Hospital of Central South University, Changsha, 410011, China.,Hunan Clinical Research Center of Ophthalmic Disease, Changsha, 410011, China
| | - Li Peng
- Department of Ophthalmology, The Second Xiangya Hospital of Central South University, Changsha, 410011, China.,Hunan Clinical Research Center of Ophthalmic Disease, Changsha, 410011, China
| | - Haoyu Li
- Department of Ophthalmology, The Second Xiangya Hospital of Central South University, Changsha, 410011, China.,Hunan Clinical Research Center of Ophthalmic Disease, Changsha, 410011, China
| | - Shirui Dai
- Department of Ophthalmology, The Second Xiangya Hospital of Central South University, Changsha, 410011, China.,Hunan Clinical Research Center of Ophthalmic Disease, Changsha, 410011, China
| | - Baihua Chen
- Department of Ophthalmology, The Second Xiangya Hospital of Central South University, Changsha, 410011, China. .,Hunan Clinical Research Center of Ophthalmic Disease, Changsha, 410011, China.
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Liang W, Liu C, Zhang X, Li L, Dou Z, Li D, Li X, Wu B, Wang M, Li S. Continuous administration of voriconazole enhances therapeutic effect for recalcitrant fungal keratitis. Eur J Ophthalmol 2021; 32:2688-2694. [PMID: 34918555 DOI: 10.1177/11206721211068628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the therapeutic effect of incorporating continuous administration of voriconazole in the treatment of recalcitrant fungal keratitis. METHODS In this prospective case study, 5 consecutive patients (5 eyes) with fungal keratitis were treated with a standard protocol after the failing maximal conventional medical treatment. The protocol involved continuous lavage of the ulcer with 1% voriconazole through an irrigator for 2 h, twice a day, combined with local and systemic antifungals. Visual acuity, slit lamp findings of the ulcer, and fungal hyphae density by confocal microscope were documented, respectively. RESULTS In 4 patients, the clinical symptoms and slit lamp examination were significantly improved after only 3 days of treatment. The hyphae were shown to decrease in number and morphologically fragmented in corneal stroma by confocal microscopy. After the infection was controlled, 2 cases required further keratoplasty. In one case, the treatment was deemed ineffective and a conjunctival flap had to be created to help control the infection. In all 5 patients, the best spectacle-corrected visual acuity had improved after treatment. With more than 3 months of follow-up, no recurrence of infection was seen in any cases. CONCLUSION Our treatment protocol demonstrated improvement in the treatment of clinically resistant fungal keratitis. Continuous lavage of voriconazole is easy to be implemented and well-tolerated by patients. Modification of the current protocol should be further explored to optimize the therapeutic effectiveness in future.
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Affiliation(s)
- Weiyan Liang
- Department of Cornea, Beijing Aier Intech Eye Hospital, Beijing, China
| | - Chang Liu
- Department of Cornea, Beijing Aier Intech Eye Hospital, Beijing, China.,Aier Cornea Institute, Beijing, China
| | - Xiansen Zhang
- Department of Cornea, Beijing Aier Intech Eye Hospital, Beijing, China
| | - Ling Li
- Department of Cornea, Beijing Aier Intech Eye Hospital, Beijing, China.,Aier Cornea Institute, Beijing, China
| | - Zexia Dou
- Department of Cornea, Beijing Aier Intech Eye Hospital, Beijing, China.,Aier Cornea Institute, Beijing, China
| | - Dandan Li
- Department of Cornea, Beijing Aier Intech Eye Hospital, Beijing, China
| | - Xinxin Li
- Department of Cornea, Beijing Aier Intech Eye Hospital, Beijing, China.,506624Aier School of Ophthalmology, Central South University, Changsha, Hunan, P.R. China
| | - Bowen Wu
- Department of Cornea, Beijing Aier Intech Eye Hospital, Beijing, China.,506624Aier School of Ophthalmology, Central South University, Changsha, Hunan, P.R. China
| | - Mingwu Wang
- Aier Cornea Institute, Beijing, China.,NeuVision Medical Institute, Arizona, USA.,Department of Ophthalmology and Visual Science, College of Medicine, 12216University of Arizona, Arizona, USA
| | - Shaowei Li
- Department of Cornea, Beijing Aier Intech Eye Hospital, Beijing, China.,Aier Cornea Institute, Beijing, China.,506624Aier School of Ophthalmology, Central South University, Changsha, Hunan, P.R. China
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Lin W, Zhao L, Huang X, Tan Q, Peng M, Khan MA, Lin D. Comparative Assessment of Distribution Characteristics and Ocular Pharmacokinetics of Norvancomycin Between Continuous Topical Ocular Instillation and Hourly Administration of Eye Drop. DRUG DESIGN DEVELOPMENT AND THERAPY 2020; 14:867-879. [PMID: 32161446 PMCID: PMC7049745 DOI: 10.2147/dddt.s233047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 02/13/2020] [Indexed: 01/04/2023]
Abstract
Background The aim of this study was to compare the distribution characteristics and ocular pharmacokinetics of norvancomycin (NVCM) in ocular tissues of the anterior segment between continuous topical ocular instillation and hourly administration of eye drop in rabbits. Methods Sixty rabbits were randomly divided into two groups: continuous topical ocular instillation drug delivery (CTOIDD) group and eye drop (control) group. In the CTOIDD group, NVCM solution (50 mg/mL) was perfused to the ocular surface using the CTOIDD system at 2 mL/h up to 10 h and the same solution was administered at one drop (50 μL) per hour for 10 h in the control group. Animals (N=6 per time-point per group) were humanely killed at 2, 4, 6, 10, and 24 h to analyze their ocular tissues and plasma. The concentrations of NVCM in the conjunctiva, cornea, aqueous humour, iris, ciliary body and plasma were measured by HPLC with photodiode array detector. The pharmacokinetic parameters were calculated by Kinetica 5.1. Results The highest concentrations of NVCM for the CTOIDD group and control group were 2105.45±919.89 μg/g and 97.18±43.14 μg/g in cornea, 3033.92±1061.95 μg/g and 806.99±563.02 μg/g in conjunctiva, 1570.19±402.87 μg/g and 46.93±23.46 μg/g in iris, 181.94±47.11 μg/g and 15.38±4.00 μg/g in ciliary body, 29.78±4.90 μg/mL and 3.20±1.48 μg/mL in aqueous humour, and 26.89±5.57 μg/mL and 1.90±1.87 μg/mL in plasma, respectively. The mean NVCM levels significantly increased at all time-points in cornea, iris, and ciliary body (p<0.05) in the CTOIDD group. The AUC0–24 values in the CTOIDD group were 27,543.70 μg·h/g in cornea, 32,514.48 μg·h/g in conjunctiva, 8631.05 μg·h/g in iris, 2194.36 μg·h/g in ciliary body and 343.9 μg·h/mL in aqueous humour, which were higher than for the eye drop group in all tissues. Conclusion Since continuous instillation of NVCM with CTOIDD could reach significantly higher concentrations and was sustained for a longer period compared with hourly administration of eye drop, CTOIDD administered NVCM could be a possible method to treat bacterial keratitis. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/mh0eyzHYgRE
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Affiliation(s)
- Wenxiang Lin
- Aier School of Ophthalmology, Central South University, Changsha, People's Republic of China.,Department of Ophthalmology, Changsha Aier Eye Hospital, Changsha, People's Republic of China
| | - Libei Zhao
- Aier School of Ophthalmology, Central South University, Changsha, People's Republic of China.,Department of Ophthalmology, Changsha Aier Eye Hospital, Changsha, People's Republic of China
| | - Xuetao Huang
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Qian Tan
- Aier School of Ophthalmology, Central South University, Changsha, People's Republic of China.,Department of Ophthalmology, Changsha Aier Eye Hospital, Changsha, People's Republic of China
| | - Manqiang Peng
- Aier School of Ophthalmology, Central South University, Changsha, People's Republic of China.,Department of Ophthalmology, Changsha Aier Eye Hospital, Changsha, People's Republic of China
| | - Muhammad Ahmad Khan
- Aier School of Ophthalmology, Central South University, Changsha, People's Republic of China.,Department of Ophthalmology, Changsha Aier Eye Hospital, Changsha, People's Republic of China
| | - Ding Lin
- Aier School of Ophthalmology, Central South University, Changsha, People's Republic of China.,Department of Ophthalmology, Changsha Aier Eye Hospital, Changsha, People's Republic of China
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