Management of fungal keratitis: Topical or Systemic therapy?

Abstract

Currently, there are no level one evidence-based studies comparing systemic vs topical therapy for the management of fungal keratitis. Information on systemic efficacy alone or in combination with topical use is rare. Selection of the most appropriate antifungal for fungal keratitis remains a challenge, hindered by the diverse clinical presentation in fungal keratitis, delay in clinical and laboratory diagnosis, limited supply of effective antifungals, lack of ocular pharmacological profiles for current antifungals, nonstandard dosing intervals/routes of administrations, expanding list of causative agents, geographic diversity and the emergence of resistance. Efficacy is gleamed from personal observations, clinical experience, literature reviews, or retrospective data from small or single cases studies and or chart reviews. Taken together, the level of existing evidence is insufficient to determine the role of systemic vs topical therapy for fungal keratitis. Topical therapy remains the standard for treatment of fungal keratitis. Adjunctive therapy with oral or intravenous antifungals may be required for severe or recalcitrant ulcers. Well-powered randomized clinical trials involving diverse and common topical vs systemic therapies are needed to address this question.

Keywords

• keratitis
• fungal
• diagnosis, therapy.