EVALUATION OF INTRA-CORNEAL INJECTION OF 5% NATAMYCIN FOR THE TREATMENT OF FUSARIUM KERATITIS Fani Segev MD, Guy Tam MD, Yossi Paitan PhD, Dvora Kidron MD Department of Ophthalmology, Microbiology & Pathology, Meir General Hospital, Kfar-Saba, Sackler School of Medicine, Tel Aviv University, Israel

DISCLOSURES  The authors have no financial interest in the subject matter of this poster

INTRODUCTION  Fungal keratitis represents a serious ophthalmic infection.  If untreated, it can lead to serious complications such as endophthalmitis, perforation and blindness.  Globally, the incidence of fungal keratitis is rising due to: Use of topical steroids Use of long -term contact lenses Increase in surgical corneal procedures  Filamentous fungi (Fusarium and Asppergillus) form the major etiologic agents of fungal keratitis.  Fungal keratitis is treated with topical antifungal agents and in severe cases with combination of oral antifungal agent.  Most of the medications have limited effectiveness, absorbs poorly, and have low potency.

OBJECTIVE  To compare the efficacy of intra-stromal injection of Natamycin 5% combined with topical Natamycin 5% to a standard therapy (Natamycin 5%) in a rabbit model of Fusarium keratitis.

METHODS  A prospective randomized case control study  Keratitis was induced in eyes of 12 NZ rabbits by intra-stromal injection of 1.6x10 5 CFU/0.1ml of Fusarium spore suspension into the central cornea

METHODS – CONT.  Rabbits were randomly divided into two groups:  Group 1:  Group 1: received intra-stromal injection of Natamycin 5% on treatment day 1 and 4 combined with topical Natamycin 5% eye-drops given hourly for the first 2 days followed by 4 times daily on days  Group 2:  Group 2: received only topical Natamycin 5% at identical interval.  Eyes were examined clinically on treatment days 1,4,7 and 11.  Extent of keratitis was graded by the following parameters: size of corneal infiltration and epithelial defect conjunctival hyperemia corneal clouding corneal neovascularization hypopion level

RESULTS  Fusarium keratitis with hypopion developed in all eyes 4 days after intra-stromal inoculation.  In both treatment groups, clinical improvement of keratitis was recorded.  Infiltration size was statistically smaller in the intra-stromal injected group (P=0.023).  Neovascularization was statistically smaller in the control group (P=0.032).

Clinical Scores during Follow-Up

Clinical Course by Day

Clinical Course GROUP 1 GROUP 2

CONCLUSIONS  Intra-stromal injection of Natamycin 5% combined with topical Natamycin 5% is an effective treatment modality for Fusarium keratitis.