article · Clinical ophthalmology
Fungal keratitis represents a significant cause of microbial keratitis capable of causing corneal blindness. Clinical care faces substantial hurdles, including difficult laboratory confirmation and limited availability or efficacy of antifungal drugs. Standard therapy relies primarily on topical antifungal agents initiated following positive smears or cultures, though topical treatment alone is frequently inadequate. Alternative administration methods such as intrastromal injections help sustain steady therapeutic drug concentrations within corneal tissue, whilst intracameral injections can address deep, unresponsive stromal infections. For surgical intervention, therapeutic keratoplasty provides an approved approach with favourable success rates. In addition, corneal collagen cross-linking serves as an emerging standalone or adjunctive option, though standardisation is ongoing. Protocols for cross-linking still require refinement regarding ultraviolet radiation fluence, exposure duration, and riboflavin concentration to achieve complete microbial eradication.
Fungal keratitis is a sight-threatening infection that often resists standard eye drop therapies. Understanding advanced drug delivery techniques, surgical interventions, and adjunctive procedures helps eye care professionals preserve vision in complex cases. Improving diagnostic and treatment pathways reduces the risk of corneal blindness, particularly where conventional antifungal treatments fail to penetrate deep corneal tissue or fully eliminate persistent fungal pathogens.
This overview indicates potential opportunities for medical device developers and pharmaceutical manufacturers to refine corneal cross-linking systems and targeted ocular drug delivery methods. Specific commercial development could focus on optimised riboflavin formulations, calibrated ultraviolet light delivery devices, and specialised injection tools for ophthalmologists. The cross-linking technology remains at an applied research stage requiring further protocol optimisation, while advanced injection techniques and therapeutic keratoplasty reflect established clinical practices.
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Fungal keratitis is one of the major causes of microbial keratitis that may lead to corneal blindness. Many problems related to diagnosis and therapy are encountered in fungal keratitis, including difficulty in obtaining laboratory diagnoses and the availability and efficacy of antifungal medications. Intensive and prolonged use of antifungal topical preparations may not be enough. The use of antifungal medications is considered the main treatment for fungal keratitis. It is recommended to start antifungal therapy after confirmation of the clinical diagnosis with a smear or positive cultures. Topical application of antifungal medications is a mainstay for the treatment of fungal keratitis; however, systemic, intra-stromal, or intra-cameral routes may be used. Therapeutic keratoplasty is the main surgical procedure approved for the management of fungal keratitis with good success rate. Intrastromal corneal injection of antifungal medications may result in steady-state drug levels within the corneal tissue and prevent intervals of decreased antifungal drug concentration below its therapeutic level. In cases of severe fungal keratitis with deep stromal infiltration not responding to treatment, intracameral injection of antifungal agents may be effective. Collagen cross-linking has been proposed to be beneficial for cases of fungal keratitis as a stand-alone therapy or as an adjunct to antifungal medications. Although collagen cross-linking has been extensively studied in the past few years, its protocol still needs many modifications to optimize UV fluence levels, irradiation time, and concentration of riboflavin to achieve 100% microbial killing.
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DOI: 10.2147/opth.s447138
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