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There are a few reports of the use of voriconazole for the treatment of fungal keratitis.1–5 We report another case of its apparent success in Aspergillus fumigatus keratitis and discuss the dilemma of prescribing an expensive drug in the absence of defined ophthalmic therapeutic levels.
A 51 year old diabetic man presented a week after being poked in his eye by a child’s finger, with a 3.0×3.5 mm central corneal ulcer overlying full thickness stromal infiltrate with associated hypopyon (fig 1). Pinhole visual acuity was 2/60 in this eye. Topical ciprofloxacin 0.3% was started. Aspergillus fumigatus was isolated after 48 hours’ incubation and topical amphotericin B 0.15%, voriconazole 1% hourly, and …