Antifungal efficacy of voriconazole, itraconazole and amphotericin b in experimental fusarium solani keratitis

Purpose: To evaluate the efficacy of topical voriconazole in an experimental rabbit model of Fusarium keratitis. Methods: Fungal keratitis was induced in the right eyes of 24 New Zealand rabbits. 8.6 × 10³ CFU/0.1 ml F.solani spore suspension was injected midstromally into the central cornea. Group 1 received topical amphotericin B 0.15%, group 2 received topical itraconazole 1% and group 3 received topical voriconazole 1% hourly between 08:00 to 22:00 on days 1 and 2; 4 times daily on days 3-5. Control group received topical balanced salt solution at identical intervals. The eyes were examined clinically with a scoring system before treatment (day 0), on day 3 and on day 5. Cultures were taken from the lesion by scraping at the end of the treatment. Clinical scores and microbiologic results were analyzed statistically. Results: In the control group, keratitis progressed clinically and colony level was 2 × 10³ CFU at day 5. In all treatment groups, progression of keratitis was inhibited clinically. Culture was sterile in the group receiving amphotericin B. Colony level was 0.3 × 10² CFU in the itraconazole group and 2 × 10² CFU in the voriconazole group at day 5. Conclusion: Progression of keratitis was inhibited clinically in all treatment groups. Colony level decreased significantly in all treatment groups. As a result, itraconazole 1% and voriconazole 1% were found to be effective in Fusarium keratitis clinically and microbiologically, although their activity was not as effective as amphotericin B 0.15%.