Intracameral Amphotericin B for Keratomycosis Dr Suresh K Pandey, Suvi Eye Kota India.mpg скачать в хорошем качестве

Intracameral Amphotericin B for Keratomycosis Dr Suresh K Pandey, Suvi Eye Kota India.mpg

In this video, Dr Suresh K Pandey & Dr Vidushi Sharma, eye surgeons of SuVi Eye Institute & Lasik Laser Centre, Kota, Rajasthan, India (www.suvieye.com) share their experience on use of intracameral amphotericin B in treatment of severe keratomycosis. Fungal keratitis is a significant cause of ocular morbidity in India. The most commonly implicated fungi are Aspergillus spp. Patients often present with hypopyon, which usually contains fungal elements. The treatment is difficult owing to poor intraocular penetration of most available antifungal agents. We have used intracameral injection of amphotericin B in natamycin resistant cases of severe keratomycosis. Most of the cases were culture proven Aspergillus flavus corneal ulcer with hypopyon not responding to topical natamycin 5%, amphotericin B 0.15%, and oral itraconazole were administered intracameral amphotericin B. All cases responded favorably, with the ulcer and hypopyon clearing completely. There was no clinical evidence of corneal or lenticular toxicity in any patient. Intracameral amphotericin B may be a useful modality in the treatment of severe keratomycosis not responding to topical natamycin. It ensures adequate drug delivery into the anterior chamber and may be especially useful to avoid surgical intervention in the acute stage of the disease. Surgery in the form of a therapeutic penetrating keratoplasty has been advocated for deep keratitis with retrocorneal or anterior chamber involvement that is unresponsive to medical therapy. However, results are often poor owing to the extensive infiltration of the anterior segment by the fungi. When fungal hyphae gain intracameral access, they are extremely difficult to eradicate. Recurrence of the infection in the graft is common and often necessitates repeated grafting. In addition, intravitreal inoculation of fungi at the time of surgery is always possible leading to the catastrophe of fungal endophthalmitis. Intracameral amphotericin B could be a very useful modality to avoid surgical intervention at an acute stage of fungal keratitis. The treatment of deep keratomycosis is complicated by the toxicity of antifungal agents irrespective of the route of administration. Intracameral amphotericin serves the purpose of drug delivery into the anterior chamber with none of the toxic features of high-concentration topical drops or systemic therapy. There are no clinically demonstrable untoward effects on the cornea with concentrations of 10 microgram in 0.1 mL. Repeated doses can be given, depending on the response. This mode of therapy may assume greater significance in the emerging situations of resistance to natamycin owing to its widespread indiscriminate use. PREPARATION OF INTRACAMERAL AMPHOTERICIN -B: Ten milliliters of distilled water for injection was added to the vial containing 50 mg lyophilized powder, giving a mixture containing 5.0 mg/mL; 1.0 mL of this was added to 4.0 mL of distilled water to further dilute it to 1.0 mg/mL. Of this concentration, 1.0 mL was then diluted with 9.0 mL of distilled water, thus making a concentration of 100 g/mL; 0.1 mL of this contained 10 g, which was injected with a 1.0-mL syringe into the anterior chamber. Contact details: Dr. Suresh K Pandey & Dr. Vidushi Sharma Directors: Suvi Eye Institute and Research Center, VISX™ Advanced CustomVue™ Lasik Laser Center, C 13 Talwandi, Kota, Rajasthan, India; Phone +91 (744) 2433575; +91 9351412449; E-mail- [email protected], www.suvieye.com #DrSureshKPandeyKota #SuViEyeHospitalKota #DrVidushiSharma #iol #ophthalmology #cataract #eye #suvieyehospitallasiklasercenterkota #cataractsurgery #eyedoctor #ophthalmologist #eyesurgery #cornea #eyes #phacoemulsification #g #glaucoma #oftalmologia #intraocularlens #optometry #lens #surgery #phaco #eyesurgeon #doctor #eyecare #vision #catarata #retina #medicine #ll #lasik #ophthalmicphotography #multifocal