Evaluation of in vitro efficiency of antifungal agents and corneal cross - linking therapy

Evaluation of In Vitro Efficiency of Antifungal Agents and Corneal Cross - Linking Therapy Purpose: To evaluate the in vitro efficiency of antifungal agents and corneal collagen cross-linking on fungal microorganisms both alone and in combined therapies. Material and Methods: The study group consisted of cases who were followed up with diagnosis of fungal keratitis at CU Faculty of Medicine Ophthalmology Department. Aspergillus terreus CBS 135845, Aspergillus flavus CBS 143253, Aspergillus fumigatus CBS 143374 defined by amplification of the calmodulin gene region and Fusarium falciforme CBS 143254, Fusarium proliferatum CBS 143256, Fusarium solani CBS 143372 defined by amplification of the elongation factor 1-alpha (tef1-a) gene region is isolated from corneal scraping samples at CU Faculty of Medicine Microbiology Department Science Laboratory. Each microorganism was divided into five groups. Therapeutic efficiency of corneal cross-linking therapy, antifungal agents, and antifungal agents together with corneal cross-linking therapy were evaluated. Findings: In this study, group A (PACK-CXL), group B (PACK-CXL+vorikonazol), group C (PACK-CXL+ amfoterisin B ), group D (PACK-CXL+ clorhexidine) and group E (only vorikonazol, amfoterisin B and clorhexidine) on four different fungal inoculum concentrations of Aspergillus terreus CBS 135845, Aspergillus flavus CBS 143253, Aspergillus fumigatus CBS 143374 ve Fusarium falciforme CBS 143254, Fusarium proliferatum CBS 143256, Fusarium solani CBS 143372 is examined statistically. We did not observe cultured microorganisms in group B, C, D, E3. Although there was a statistically significant decrease in number of microorganisms, we detected microorganism recurrence in groups A, E1 and E2. In group E, the activities of voriconazole, amphotericin B and chlorhexidine alone were evaluated. There was no growth after the use of 0.02% chlorhexidine in mold fungi, whereas there was a decrease in the number of microorganisms after voriconazole and amphotericin B application. These findings indicate %0.02 chlorhexidine, voriconazole and amphotericin B have similar fungicidal effect on mold isolates. Conclusions: Corneal collagen cross-linking with %0.1 riboflavin and antifungal agents either alone or combine has enough fungal killing rate in filamentous fungal keratitis. It was also found that 0.02% chlorhexidine used as an antiseptic had enough fungal killing rate in filamentous fungal keratitis. It is appropriate to add corneal collagen cross-linking and %0.02 clorhexidine either alone or combined with antifungal agents in fungal keratitis treatment algorithm. Key words: Fungal keratitis, corneal cross-linking, %0.02 clorhexidine, PACK-CXL