{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T15:48:30Z","timestamp":1765295310851,"version":"3.44.0"},"reference-count":11,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,1,11]]},"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:p>We describe the management of a referred man in his 50s with corneal ulcer in the left eye. Slit-lamp biomicroscopy revealed an infiltrate (4.5\u00d73.5 mm), involving full corneal thickness, corneal melt less than one-third corneal thickness and hypopyon (3.0 mm). Branched septate hypha on direct microscopy and <jats:italic>Aspergillus flavus<\/jats:italic> in Sabaraud\u2019s dextrose agar confirmed the clinical diagnosis of fungal corneal ulcer. We used natamycin 5% suspension 1 hourly, voriconazole 1% 1 hourly, gatifloxacin 0.5% three times and atropine 1% three times per day, for 2 weeks. However, there was no improvement and the corneal melt increased. We used intracameral plus intracorneal voriconazole injection with voriconazole-impregnated amniotic membrane transplant. We observed a significant decrease in conjunctival congestion, size\/depth of infiltrate and hypopyon at the first week of antifungal therapy. Subsequently, at 6 weeks, corneal infiltrate had decreased and superficial corneal vascularisation appeared. Later, at 12 weeks, the patient developed corneal opacity.<\/jats:p>","DOI":"10.1136\/bcr-2021-246659","type":"journal-article","created":{"date-parts":[[2022,3,29]],"date-time":"2022-03-29T12:10:48Z","timestamp":1648555848000},"page":"e246659","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Voriconazole-impregnated multilayered AMT and intracorneal plus intracameral injection in recalcitrant fungal corneal ulcer"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0169-7033","authenticated-orcid":false,"given":"Ashok","family":"Sharma","sequence":"first","affiliation":[{"name":"Ophthalmology, Cornea Center, Chandigarh, India"},{"name":"Dr Ashok Sharma's Cornea Centre, Chandigarh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rajan","family":"Sharma","sequence":"additional","affiliation":[{"name":"Ophthalmology, Cornea Centre, Chandigarh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Verinder S","family":"Nirankari","sequence":"additional","affiliation":[{"name":"University of Maryland School of Medicine, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,3,29]]},"reference":[{"key":"2025082709030612000_15.3.e246659.1","doi-asserted-by":"publisher","DOI":"10.1136\/bjo.81.11.965"},{"key":"2025082709030612000_15.3.e246659.2","doi-asserted-by":"publisher","DOI":"10.1007\/s12281-013-0150-1"},{"key":"2025082709030612000_15.3.e246659.3","doi-asserted-by":"publisher","DOI":"10.1136\/bjo.74.1.40"},{"key":"2025082709030612000_15.3.e246659.4","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000000541","article-title":"Treatment with intrastromal and intracameral voriconazole in 2 eyes with Lasiodiplodia theobromae keratitis","volume":"94","author":"Lekhanont","year":"2015","journal-title":"Medicine"},{"key":"2025082709030612000_15.3.e246659.5","doi-asserted-by":"crossref","first-page":"35","DOI":"10.4103\/ijo.IJO_378_19","article-title":"Intrastromal voriconazole: an adjuvant approach for recalcitrant mycotic keratitis","volume":"68","author":"Konar","year":"2020","journal-title":"Indian J Ophthalmol"},{"key":"2025082709030612000_15.3.e246659.6","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1097\/ICO.0000000000001781","article-title":"Management algorithm for fungal keratitis: the TST (topical, systemic, and targeted therapy) protocol","volume":"38","author":"Sharma","year":"2019","journal-title":"Cornea"},{"key":"2025082709030612000_15.3.e246659.7","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01125-08"},{"key":"2025082709030612000_15.3.e246659.8","doi-asserted-by":"crossref","first-page":"1068","DOI":"10.4103\/ijo.IJO_2649_20","article-title":"Drug reservoir function of voriconazole impregnated human amniotic membrane: An in vitro study","volume":"69","author":"Hazarika","year":"2021","journal-title":"Indian J Ophthalmol"},{"key":"2025082709030612000_15.3.e246659.9","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2018-226498","article-title":"Periocular contact dermatitis with use of topical voriconazole 1% in mycotic keratitis","volume":"16","author":"Sahay","year":"2018","journal-title":"BMJ Case Rep"},{"key":"2025082709030612000_15.3.e246659.10","doi-asserted-by":"crossref","DOI":"10.1155\/2018\/1875627","article-title":"Corneal debridement combined with intrastromal voriconazole for recalcitrant fungal keratitis","volume":"2018","author":"Sun","year":"2018","journal-title":"J Ophthalmol"},{"key":"2025082709030612000_15.3.e246659.11","doi-asserted-by":"crossref","DOI":"10.1155\/2016\/3436415","article-title":"A combination of intrastromal and intracameral injections of amphotericin B in the treatment of severe fungal keratitis","volume":"2016","author":"Hu","year":"2016","journal-title":"J Ophthalmol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-246659","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T16:03:13Z","timestamp":1756310593000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-246659"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3]]},"references-count":11,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,3,29]]},"published-print":{"date-parts":[[2022,3]]}},"alternative-id":["10.1136\/bcr-2021-246659"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-246659","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2022,3]]}}}