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I have read the article entitled "Intrastromal voriconazole for deep
recalcitrant fungal keratitis: a case series" by Kalaiselvi et al. with
interest.1 The authors investigated the efficacy of intrastromal
voriconazole injection in the management of deep recalcitrant fungal
keratitis and found it safe and effective. I would like to contribute to
the article in terms of clinical practice.
The authors' choice was voriconazole as an antifungal agent, and it
seems reasonable because of its' safety and potency on various fungal
species especially aspergillus spp. On the other hand, itraconazole could
also be studied due to a distinct characteristic of it. Goktas et al.
revealed that itraconazole can reduce corneal neovascularization.2
Recalcitrant corneal infections usually result in corneal scars and
sometimes corneal neovascularizations. Therefore; intrastromal
administration of itraconazole would be more beneficial in which cases the
infectious agents are found sensitive to itraconazole.
Zeng et al. have recently reported that amniotic membrane covering
(AMC) may enhance cornea epithelial regeneration after debridement of
fungal keratitis.3 I suppose that AMC could be helpful alone or in
combination with intrastromal administration of antifungal agents. It will
promote wound healing, support corneal integrity and decrease the risk of
perforation due to such persistent fungal infections.