1Ruokonen P., 3Tintelnot K., 1Kojetinsky C., 2Ruhnke M., 1Anders N.

1Dept. Of Ophthalmology, 2Internal Medicine of Universitätsklinikum Charité, Humbolt-University, Augustenburger Platz 1, D-13353 Berlin; 3Robert-Koch-Institute Berlin, Norduferstr. 20, D-13353 Berlin

Background: Treatment of invasive ocular hyphomycosis with orale azoles is usually ineffective and has, even with Amphotericin B intravenious, a very bad prognosis and many side effects.
Patients and methods: After failure of therapy with systemic Diflucane and systemic and topic Amphotericin B, two patients with histologically proven corneal mould infection were treated with Voriconazol, a new azole, situated in phase III of clinical check-up, systemical (4mg/kg i.v. or p.o. twice a day), intracameral (3mµg/ml) and topical (1%/h).
Results: The attempt to culture fungi failed in both cases. In the first case, in spite of a systemic Amphotericin B administration, a perforating keratoplasty à chaud had to be performed after development of a central descemetocele and impending perforation. A following recurrance of the Hyalohyphomycosis (histological detection in the explanted cornea, likely Fusariosis), was curable by use of systemic Voriconazole. The second patient stopped the intravenious Amphotericin B treatment. In the following days a severe deterioration could be found. Despite the application of Voriconazole the eye has to be enucleated. With PCR Aspergillus spp. was detected.
Conclusions: Voriconazole is a antimycotic drug, which allows both, intravenious and oral administration. Besides a transient elevation of liver enzymes no further side effects were found. A topical administration, even as lavage of the anterior chamber, was tolerated well.

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