Background: Voriconazole has an important role to play in the prophylaxis and management of fungal endophthalmitis and keratitis. New-generation triazoles, including voriconazole, posaconazole and ravuconazole, have been shown in laboratory studies and clinical experience to have very good safety profiles with few side effects. Fungal eye infections, while not common in temperate climates, have been notoriously difficult to diagnose and treat, and generally result in protracted therapy with poor final outcomes. Current treatment options are far from optimal.
Aims: This paper will review studies and clinical case reports published in the ophthalmic literature that address the safety of these drugs in the eye, penetration and concentration in ocular tissues and media, and efficacy in treating common pathogens implicated in fungal keratitis and endophthalmitis.
Conclusions: Over 40 clinical case reports of treatment with voriconazole suggest that it may be used safely and effectively against a broad range of fungal pathogens.
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Funding: Funding was received from Pfizer for technical research assistance in preparing this manuscript. SMH’s research was supported by an unrestricted grant from the Research to Prevent Blindness Organization, New York, NY.
Competing interests: SMH, WFM and TKL have no competing interests. WES has received grants from Pfizer and other competing organisations such as Fujisawa. JRG has received grants from Merck, Pfizer and Schering. He is also on the Merck and Schering advisory board.