Treatment of Severe Fungal Keratitis with Subconjunctival Amphotericin B

Purpose: To report the beneficial properties of subconjunctival amphotericin B as an adjunctive therapy in patients with severe fungal keratitis.

Methods: Case reports and review of medical literature. Four patients with advanced fungal keratitis were treated with repeated injections of subconjunctival amphotericin B in addition to topical and systemic antifungal treatment.

Results: Two to 8 injections were given to each patient. All patients showed rapid clinical improvement after the injections. No serious adverse effects were observed. However, all patients experienced pain during the injections.

Conclusions: Subconjunctival injections of amphotericin B are useful as an adjunctive treatment of advanced fungal keratitis. This treatment assures compliance and may be an alternative to avoid a surgical intervention in an acute stage of advanced fungal keratitis. More cases are needed to validate our findings.