An intracameral approach for recalcitrant fungal keratitis

PURPOSE: To describe 2 cases of recalcitrant fungal keratitis successfully treated with intracameral Amphotericin B. METHODS: Interventional case series. RESULTS: A 59-year-old female and a 41-year-old male each presented with fungal keratitis, caused by Bipolaris spp. and Fusarium spp. respectively. Both cases were unresponsive to topical antifungals, causing persistent discomfort and decreased vision. The two patients subsequently received a single dose of intracameral amphotericin B (ICAMB) 10mcg/0.1 mL, in addition to continued topical natamycin. Both patients had remarkable results following ICAMB, with best corrected visual acuity of 20/20 and full corneal reepithelization following treatment. CONCLUSIONS: We report 2 cases of intractable fungal keratitis that benefited from intracameral injections of amphotericin B. This route of delivery appears to be very effective because the medication is delivered directly to the deeper layers of the cornea, where fungal infections tend to reside, and where topical and systemic routes have difficulty accessing.