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Purpose <p>To evaluate the clinical efficacy of intrastromal injection of 0.5% (5&#xa0;mg/mL) voriconazole in fungal keratitis (FK) involving different corneal stromal depths.</p> Methods <p>This was a non-randomized, retrospective study based on patient treatment preferences. A total of 53 patients (53 eyes) with confirmed fungal keratitis treated between March 2021 and December 2023 were enrolled. Based on anterior segment optical coherence tomography (AS-OCT) findings, lesions were stratified by depth into superficial stromal involvement (Group A, <i>n</i> = 29) and deep stromal involvement (Group B, <i>n</i> = 24). Each group was further subdivided according to treatment modality: non-injection group (conventional antifungal therapy) (subgroups A1 and B1) versus injection group (conventional antifungal therapy combined with intrastromal voriconazole injection) (subgroups A2 and B2). The following clinical parameters were compared among the four subgroups: reduction ratio of corneal epithelial staining area at 7 days post-treatment initiation, best-corrected visual acuity (BCVA), corneal epithelial healing time, clinical cure time, and final clinical outcomes.</p> Results <p>All groups demonstrated significant reduction in ulcer area after 7 days of treatment (<i>P</i> &lt; 0.05). In superficial stromal fungal keratitis, ulcer improvement rates were comparable between groups A1 (37.19%) and A2 (36.11%) (<i>P</i> = 0.838). In deep stromal fungal keratitis, group B2 (41.30%) showed significantly greater improvement compared to B1 (14.95%) (<i>P</i> &lt; 0.0001). Final BCVA improved significantly in all groups, with no significant intergroup differences. Epithelial healing time and clinical cure time showed no significant differences across groups. The overall clinical cure rate was 98.1%, achieved through the non-injection group in 79.2% of cases and the injection group in 18.9% of cases. Treatment failure occurred in one case (1.9%).</p> Conclusions <p>Intrastromal voriconazole injection provides no additional benefit for superficial stromal fungal keratitis compared with conventional topical therapy and is therefore not recommended as routine treatment given its invasive nature. For deep stromal fungal keratitis, intrastromal injection demonstrates superior early lesion control but does not reduce overall disease duration or improve final visual outcomes. Further large-scale prospective studies are warranted to establish its optimal indications and clinical value.</p>

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Clinical efficacy of intrastromal voriconazole injection in fungal keratitis involving different corneal stromal depths

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月16日

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  • Hui Huang,
  • Chaoting MO,
  • Zhou Zhou,
  • Li Jiang,
  • Guoqing Chen,
  • Yuanhua Li,
  • Binghua Chen,
  • Yaling Li,
  • Fen Tang,
  • Chaolan Shen,
  • Mingliang Lv,
  • Ning Su,
  • Fengmei Li,
  • Ling Cui,
  • Fan Xu,
  • Qi Chen,
  • Haibin Zhong,
  • Qianqian Lan

摘要

Purpose

To evaluate the clinical efficacy of intrastromal injection of 0.5% (5 mg/mL) voriconazole in fungal keratitis (FK) involving different corneal stromal depths.

Methods

This was a non-randomized, retrospective study based on patient treatment preferences. A total of 53 patients (53 eyes) with confirmed fungal keratitis treated between March 2021 and December 2023 were enrolled. Based on anterior segment optical coherence tomography (AS-OCT) findings, lesions were stratified by depth into superficial stromal involvement (Group A, n = 29) and deep stromal involvement (Group B, n = 24). Each group was further subdivided according to treatment modality: non-injection group (conventional antifungal therapy) (subgroups A1 and B1) versus injection group (conventional antifungal therapy combined with intrastromal voriconazole injection) (subgroups A2 and B2). The following clinical parameters were compared among the four subgroups: reduction ratio of corneal epithelial staining area at 7 days post-treatment initiation, best-corrected visual acuity (BCVA), corneal epithelial healing time, clinical cure time, and final clinical outcomes.

Results

All groups demonstrated significant reduction in ulcer area after 7 days of treatment (P < 0.05). In superficial stromal fungal keratitis, ulcer improvement rates were comparable between groups A1 (37.19%) and A2 (36.11%) (P = 0.838). In deep stromal fungal keratitis, group B2 (41.30%) showed significantly greater improvement compared to B1 (14.95%) (P < 0.0001). Final BCVA improved significantly in all groups, with no significant intergroup differences. Epithelial healing time and clinical cure time showed no significant differences across groups. The overall clinical cure rate was 98.1%, achieved through the non-injection group in 79.2% of cases and the injection group in 18.9% of cases. Treatment failure occurred in one case (1.9%).

Conclusions

Intrastromal voriconazole injection provides no additional benefit for superficial stromal fungal keratitis compared with conventional topical therapy and is therefore not recommended as routine treatment given its invasive nature. For deep stromal fungal keratitis, intrastromal injection demonstrates superior early lesion control but does not reduce overall disease duration or improve final visual outcomes. Further large-scale prospective studies are warranted to establish its optimal indications and clinical value.