Ayse Kalkanci1, Nilufer Yesilirmak2, Hüseyin Baran Ozdemir3, Elif Ayca Unal1, Merve Erdoğan1, Tamay Seker4, Atakan Emre Tum5, Ahmet Kamil Karakus5, Kenan Hizel6, Kamil Bilgihan7. 1. Department of Medical Microbiology, Gazi University Faculty of Medicine, Ankara, Turkey. 2. Department of Ophthalmology, Yildirim Beyazit University, Ankara, Turkey. 3. Ankara Ulucanlar Eye Training and Research Hospital, University of Health Science, Ankara, Turkey. 4. Middle East Technical University, Central Laboratory, Molecular Biology-Biotechnology Research and Development Center, Mass Spectroscopy Laboratory, Ankara, Turkey. 5. Gazi University Faculty of Medicine, Phase 4 Student, Ankara, Turkey. 6. Department of Infectious Diseases, University Faculty of Medicine, Ankara, Turkey. 7. Department of Ophthalmology, Gazi University Faculty of Medicine, Ankara, Turkey.
Abstract
PURPOSE: To investigate voriconazole (VRZ) penetration and fungal load in the cornea after applying VRZ therapy with various treatment combinations in a fungal keratitis model. METHODS: Fifty-four eyes of 27 young albino rabbits were provided for this experimental study. Twelve corneas were inoculated with Candida albicans, 12 corneas were inoculated with Fusarium solani, and 6 eyes were selected as controls. Infected corneas received various treatment combinations including VRZ 1% drop therapy alone, VRZ 1% plus amphotericin B 1% drop combination therapy, iontophoretic VRZ therapy, and VRZ 1% drop therapy after corneal cross-linking. Fungal load was measured by log reduction, and VRZ levels were quantified by liquid chromatography-tandem mass spectrometry. RESULTS: Iontophoresis-assisted VRZ application showed the highest antifungal activity against F. solani keratitis (4-log reduction) and C. albicans keratitis (5-log reduction) compared with other treatment applications. VRZ levels were also found to be the highest in corneas that received iontophoretic VRZ treatment (3.6313 ± 0.0990 ppb for F.solani keratitis and 1.7001 ± 0.0065 ppb for C. albicans keratitis) compared with other treatment applications. CONCLUSIONS: Iontophoresis seems to provide the highest VRZ concentration and highest antifungal activity in the cornea compared with other treatment applications for C. albicans and F. solani keratitis.
PURPOSE: To investigate voriconazole (VRZ) penetration and fungal load in the cornea after applying VRZ therapy with various treatment combinations in a fungal keratitis model. METHODS: Fifty-four eyes of 27 young albino rabbits were provided for this experimental study. Twelve corneas were inoculated with Candida albicans, 12 corneas were inoculated with Fusarium solani, and 6 eyes were selected as controls. Infected corneas received various treatment combinations including VRZ 1% drop therapy alone, VRZ 1% plus amphotericin B 1% drop combination therapy, iontophoretic VRZ therapy, and VRZ 1% drop therapy after corneal cross-linking. Fungal load was measured by log reduction, and VRZ levels were quantified by liquid chromatography-tandem mass spectrometry. RESULTS: Iontophoresis-assisted VRZ application showed the highest antifungal activity against F. solanikeratitis (4-log reduction) and C. albicanskeratitis (5-log reduction) compared with other treatment applications. VRZ levels were also found to be the highest in corneas that received iontophoretic VRZ treatment (3.6313 ± 0.0990 ppb for F.solanikeratitis and 1.7001 ± 0.0065 ppb for C. albicanskeratitis) compared with other treatment applications. CONCLUSIONS: Iontophoresis seems to provide the highest VRZ concentration and highest antifungal activity in the cornea compared with other treatment applications for C. albicans and F. solanikeratitis.