{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T01:28:37Z","timestamp":1792718917084,"version":"4.5.0"},"reference-count":117,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract:<\/jats:title>\n                  <jats:p>\n                    Fungal keratitis is a major cause of corneal blindness, particularly in tropical and low-resource settings, and remains challenging to manage due to delayed diagnosis, limited drug penetration, emerging resistance, and host-mediated tissue damage. Conventional antifungal therapies, including natamycin and voriconazole, are often inadequate in deep, severe, or refractory infections, underscoring the need for alternative strategies. This narrative review summarizes and critically appraises emerging treatments in fungal keratitis, with a focus on recent pharmacological advances, innovative drug delivery systems, adjunctive therapies, and immunomodulatory approaches. Newer-generation azoles, echinocandins, and repurposed agents are discussed alongside advanced formulations such as liposomal amphotericin B, solubilized natamycin, nanoparticle-based delivery, and intrastromal drug administration. Adjunctive modalities, including photo-activated corneal cross-linking, photodynamic therapy, therapeutic contact lenses, and low-temperature plasma, are reviewed for their antimicrobial and corneal-stabilizing effects. The role of immunomodulators in mitigating excessive inflammation while preserving antifungal defense is also highlighted. In addition, evolving strategies for managing infections caused by emerging and fungus-like pathogens, including Pythium\n                    <jats:italic toggle=\"yes\">sp<\/jats:italic>\n                    ., are addressed. While many of these therapies show promising experimental and early clinical outcomes, robust randomized controlled trials and standardized treatment protocols remain limited. This review emphasizes the need for translational research, ocular-specific antifungal development, and integrated therapeutic approaches to improve visual outcomes and reduce the burden of fungal keratitis.\n                  <\/jats:p>","DOI":"10.4103\/sjopt.sjopt_492_25","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T15:19:55Z","timestamp":1781018395000},"page":"145-153","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Emerging treatments in fungal keratitis"],"prefix":"10.4103","volume":"40","author":[{"given":"Aafreen","family":"Bari","sequence":"first","affiliation":[{"name":"Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tushar","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajesh","family":"Sinha","sequence":"additional","affiliation":[{"name":"Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"key":"R1-20260610","doi-asserted-by":"crossref","first-page":"e49","DOI":"10.1016\/S1473-3099(20)30448-5","article-title":"The global incidence and diagnosis of fungal keratitis","volume":"21","author":"Brown","year":"2021","journal-title":"Lancet Infect Dis"},{"key":"R2-20260610","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.3390\/jof8101047","article-title":"The case for fungal keratitis to be accepted as a neglected tropical disease","volume":"8","author":"Brown","year":"2022","journal-title":"J Fungi (Basel)"},{"key":"R3-20260610","doi-asserted-by":"crossref","first-page":"698780","DOI":"10.3389\/fcimb.2021.698780","article-title":"Distribution, prevalence, and causative agents of fungal keratitis: A systematic review and meta-analysis (1990 to 2020)","volume":"11","author":"Ahmadikia","year":"2021","journal-title":"Front Cell Infect Microbiol"},{"key":"R4-20260610","first-page":"6395840","article-title":"Fungal Keratitis: Epidemiology, Rapid Detection, and Antifungal Susceptibilities of Fusarium and Aspergillus Isolates from Corneal Scrapings","author":"Manikandan","year":"2019","journal-title":"Biomed Res Int 2019"},{"key":"R5-20260610","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1128\/CMR.16.4.730-797.2003","article-title":"Current perspectives on ophthalmic mycoses","volume":"16","author":"Thomas","year":"2003","journal-title":"Clin Microbiol Rev"},{"key":"R6-20260610","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1001\/jamaophthalmol.2013.1497","article-title":"Mycotic Ulcer Treatment Trial Group. The mycotic ulcer treatment trial: a randomized trial comparing natamycin vs voriconazole","volume":"131","author":"Prajna","year":"2013","journal-title":"JAMA Ophthalmol"},{"key":"R7-20260610","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1001\/jamaophthalmol.2016.4096","article-title":"Mycotic Ulcer Treatment Trial II Group. Effect of Oral Voriconazole on Fungal Keratitis in the Mycotic Ulcer Treatment Trial II (MUTT II): A Randomized Clinical Trial","volume":"134","author":"Prajna","year":"2016","journal-title":"JAMA Ophthalmol"},{"key":"R8-20260610","first-page":"597","article-title":"Natamycin in the treatment of fungal keratitis: a systematic review and Meta-analysis","volume":"8","author":"Qiu","year":"2015","journal-title":"Int J Ophthalmol"},{"key":"R9-20260610","doi-asserted-by":"crossref","first-page":"1735","DOI":"10.4103\/IJO.IJO_2351_24","article-title":"Correlation between corneal concentration and minimum inhibitory concentration of antifungals in patients undergoing therapeutic keratoplasty for fungal keratitis","volume":"73","author":"Patil","year":"2025","journal-title":"Indian J Ophthalmol"},{"key":"R10-20260610","doi-asserted-by":"crossref","first-page":"346","DOI":"10.4103\/0301-4738.185592","article-title":"Recent advances in diagnosis and management of Mycotic Keratitis","volume":"64","author":"Maharana","year":"2016","journal-title":"Indian J Ophthalmol"},{"key":"R11-20260610","doi-asserted-by":"crossref","first-page":"1828","DOI":"10.4254\/wjh.v7.i14.1828","article-title":"Voriconazole and the liver","volume":"7","author":"Mih\u0103il\u0103","year":"2015","journal-title":"World J Hepatol"},{"key":"R12-20260610","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.3390\/biomedicines11041063","article-title":"Antifungal Drug Resistance: An Emergent Health Threat","volume":"11","author":"Vitiello","year":"2023","journal-title":"Biomedicines"},{"key":"R13-20260610","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1128\/CMR.12.4.501","article-title":"Antifungal agents: mode of action, mechanisms of resistance, and correlation of these mechanisms with bacterial resistance","volume":"12","author":"Ghannoum","year":"1999","journal-title":"Clin Microbiol Rev"},{"key":"R14-20260610","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.tjo.2016.04.007","article-title":"Candida parapsilosis keratitis treated successfully with topical and oral fluconazole","volume":"6","author":"Li","year":"2016","journal-title":"Taiwan J Ophthalmol"},{"key":"R15-20260610","first-page":"173","article-title":"Efficacy of topical and systemic itraconazole as a broad-spectrum antifungal agent in mycotic corneal ulcer. A preliminary study","volume":"49","author":"Agarwal","year":"2001","journal-title":"Indian J Ophthalmol"},{"key":"R16-20260610","first-page":"241","article-title":"Voriconazole: the newest triazole antifungal agent","volume":"16","author":"Greer","year":"2003","journal-title":"Proc (Bayl Univ Med Cent)"},{"key":"R17-20260610","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1001\/archophthalmol.2010.102","article-title":"Comparison of natamycin and voriconazole for the treatment of fungal keratitis","volume":"128","author":"Prajna","year":"2010","journal-title":"Arch Ophthalmol"},{"key":"R18-20260610","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1517\/13543784.15.6.579","article-title":"Newer triazole antifungal agents: pharmacology, spectrum, clinical efficacy and limitations","volume":"15","author":"Aperis","year":"2006","journal-title":"Expert Opin Investig Drugs"},{"key":"R19-20260610","doi-asserted-by":"crossref","first-page":"852","DOI":"10.1097\/ICO.0000000000002832","article-title":"High-Dose Oral Posaconazole for the Treatment of Recalcitrant Fungal Keratitis","volume":"41","author":"Ferguson","year":"2022","journal-title":"Cornea"},{"key":"R20-20260610","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1097\/ICO.0000000000000143","article-title":"Successful treatment of Paecilomyces lilacinus keratitis with oral posaconazole","volume":"33","author":"Arnoldner","year":"2014","journal-title":"Cornea"},{"key":"R21-20260610","doi-asserted-by":"crossref","first-page":"64","DOI":"10.4103\/IJO.IJO_1811_24","article-title":"Evaluation of topical 1% posaconazole therapy in refractory fungal keratitis","volume":"73","author":"Vanathi","year":"2025","journal-title":"Indian J Ophthalmol"},{"key":"R22-20260610","doi-asserted-by":"crossref","first-page":"1369","DOI":"10.1080\/02713683.2020.1749669","article-title":"Corneal Pharmacokinetics of Voriconazole and Posaconazole following Intrastromal Injection and Posaconazole Eye Drops Instillation in Rats","volume":"45","author":"Gueudry","year":"2020","journal-title":"Curr Eye Res"},{"key":"R23-20260610","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1186\/s12879-021-05768-7","article-title":"Identification and molecular characterization of Subramaniula asteroides causing human fungal keratitis: a case report","volume":"21","author":"Cultrera","year":"2021","journal-title":"BMC Infect Dis"},{"key":"R24-20260610","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1016\/j.jfo.2019.06.014","article-title":"In vitro activity of isavuconazole against three species of Acanthamoeba","volume":"43","author":"Brunet","year":"2020","journal-title":"J Fr Ophtalmol"},{"key":"R25-20260610","doi-asserted-by":"crossref","first-page":"681","DOI":"10.3390\/pathogens9090681","article-title":"In Vitro Effect of Pitavastatin and Its Synergistic Activity with Isavuconazole against Acanthamoeba castellanii","volume":"9","author":"Hahn","year":"2020","journal-title":"Pathogens"},{"key":"R26-20260610","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.1128\/AAC.46.6.1723-1727.2002","article-title":"In vitro activities of ravuconazole and voriconazole compared with those of four approved systemic antifungal agents against 6,970 clinical isolates of Candida spp","volume":"46","author":"Pfaller","year":"2002","journal-title":"Antimicrob Agents Chemother"},{"key":"R27-20260610","doi-asserted-by":"crossref","first-page":"e00643","DOI":"10.1128\/AAC.00643-20","article-title":"In Vitro Activities of Ravuconazole and Isavuconazole against Dematiaceous Fungi","volume":"64","author":"Zheng","year":"2020","journal-title":"Antimicrob Agents Chemother"},{"key":"R28-20260610","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1007\/s11046-023-00783-5","article-title":"Antifungal Efficacy of Luliconazole in an Experimental Rabbit Model of Fungal Keratitis Caused by Fusarium solani","volume":"188","author":"Arimoto","year":"2023","journal-title":"Mycopathologia"},{"key":"R29-20260610","doi-asserted-by":"crossref","first-page":"2052","DOI":"10.3390\/pharmaceutics14102052","article-title":"Development of a Luliconazole Nanoemulsion as a Prospective Ophthalmic Delivery System for the Treatment of Fungal Keratitis: In Vitro and In Vivo Evaluation","volume":"14","author":"Yang","year":"2022","journal-title":"Pharmaceutics"},{"key":"R30-20260610","doi-asserted-by":"crossref","first-page":"3852","DOI":"10.1016\/j.apsb.2025.06.013","article-title":"Next-generation antifungal drugs: Mechanisms, efficacy, and clinical prospects","volume":"15","author":"Lu","year":"2025","journal-title":"Acta Pharm Sin B"},{"key":"R31-20260610","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1097\/ICO.0000000000003790","article-title":"Topical Caspofungin 0.5% Monotherapy for Filamentous Fungal Keratitis","volume":"45","author":"Atighehchian","year":"2026","journal-title":"Cornea"},{"key":"R32-20260610","first-page":"Doc19","article-title":"Successful management of recalcitrant fungal keratitis with topical caspofungin","volume":"12","author":"Goel","year":"2022","journal-title":"GMS Ophthalmol Cases"},{"key":"R33-20260610","doi-asserted-by":"crossref","first-page":"336","DOI":"10.3341\/kjo.2020.0021","article-title":"Fungal Keratitis Caused by Candida orthopsilosis Successfully Treated with Caspofungin","volume":"34","author":"Kim","year":"2020","journal-title":"Korean J Ophthalmol"},{"key":"R34-20260610","doi-asserted-by":"crossref","first-page":"348","DOI":"10.3390\/gels9040348","article-title":"Caspofungin-Loaded Formulations for Treating Ocular Infections Caused by Candida spp","volume":"9","author":"P\u00e9rez-Gonz\u00e1lez","year":"2023","journal-title":"Gels"},{"key":"R35-20260610","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1080\/20415990.2024.2379756","article-title":"A novel liposomal formulation for ocular delivery of caspofungin: an experimental study by quality by design-based approach","volume":"15","author":"Macwan","year":"2024","journal-title":"Ther Deliv"},{"key":"R36-20260610","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1097\/01.ico.0000154390.28254.54","article-title":"Successful topical application of a new antifungal agent, micafungin, in the treatment of refractory fungal corneal ulcers: report of three cases and literature review","volume":"24","author":"Matsumoto","year":"2005","journal-title":"Cornea"},{"key":"R37-20260610","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1097\/ICO.0b013e31802cd8a8","article-title":"Comparison of micafungin and fluconazole for experimental Candida keratitis in rabbits","volume":"26","author":"Hiraoka","year":"2007","journal-title":"Cornea"},{"key":"R38-20260610","doi-asserted-by":"crossref","first-page":"1406","DOI":"10.1136\/bjo.2010.191734","article-title":"The comparison of solitary topical micafungin or fluconazole application in the treatment of Candida fungal keratitis","volume":"95","author":"Matsumoto","year":"2011","journal-title":"Br J Ophthalmol"},{"key":"R39-20260610","doi-asserted-by":"crossref","first-page":"51","DOI":"10.2147\/IDR.S4796","article-title":"Anidulafungin and its role in candida infections","volume":"2","author":"Cappelletty","year":"2009","journal-title":"Infect Drug Resist"},{"key":"R40-20260610","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/S0140-6736(22)02324-8","article-title":"ReSTORE trial investigators. Rezafungin versus caspofungin for treatment of candidaemia and invasive candidiasis (ReSTORE): a multicentre, double-blind, double-dummy, randomised phase 3 trial","volume":"401","author":"Thompson","year":"2023","journal-title":"Lancet"},{"key":"R41-20260610","doi-asserted-by":"crossref","first-page":"e70362","DOI":"10.1111\/cts.70362","article-title":"Ibrexafungerp: Mechanism of Action, Clinical, and Translational Science","volume":"18","author":"Walley","year":"2025","journal-title":"Clin Transl Sci"},{"key":"R42-20260610","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1080\/17460913.2025.2544443","article-title":"Clinical impact of fluconazole-resistant Candida parapsilosis: a narrative review","volume":"20","author":"Bartalucci","year":"2025","journal-title":"Future Microbiol"},{"key":"R43-20260610","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/j.ijpharm.2007.04.028","article-title":"Liposomal amphotericin B eye drops to treat fungal keratitis: physico-chemical and formulation stability","volume":"344","author":"Morand","year":"2007","journal-title":"Int J Pharm"},{"key":"R44-20260610","doi-asserted-by":"crossref","first-page":"518","DOI":"10.4103\/ijo.IJO_1474_22","article-title":"Evaluation of liposomal amphotericin B for the treatment of fungal keratitis in a tertiary eye care hospital","volume":"71","author":"Kumar","year":"2023","journal-title":"Indian J Ophthalmol"},{"key":"R45-20260610","doi-asserted-by":"crossref","first-page":"118808","DOI":"10.1016\/j.ijpharm.2019.118808","article-title":"Amphotericin B containing microneedle ocular patch for effective treatment of fungal keratitis","volume":"572","author":"Roy","year":"2019","journal-title":"Int J Pharm"},{"key":"R46-20260610","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.1016\/j.jiac.2021.04.020","article-title":"Intraocular penetration of liposomal amphotericin B after intravenous injection in inflamed human eyes","volume":"27","author":"Ando","year":"2021","journal-title":"J Infect Chemother"},{"key":"R47-20260610","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1097\/ICO.0000000000003704","article-title":"Comparative Evaluation of Topical Monotherapy (Natamycin or Natasol) and Combination Therapy (Natamycin and Voriconazole) in Mild-Moderate Fungal Keratitis","volume":"44","author":"Reddy","year":"2024","journal-title":"Cornea"},{"key":"R48-20260610","doi-asserted-by":"crossref","first-page":"3522","DOI":"10.1128\/AAC.46.11.3522-3531.2002","article-title":"Action of chlorhexidine digluconate against yeast and filamentous forms in an early-stage Candida albicans biofilm","volume":"46","author":"Suci","year":"2002","journal-title":"Antimicrob Agents Chemother"},{"key":"R49-20260610","doi-asserted-by":"crossref","first-page":"798","DOI":"10.3390\/antibiotics12050798","article-title":"Chlorhexidine Resistance or Cross-Resistance, That Is the Question","volume":"12","author":"Abbood","year":"2023","journal-title":"Antibiotics (Basel)"},{"key":"R50-20260610","doi-asserted-by":"crossref","first-page":"e000698","DOI":"10.1136\/bmjophth-2020-000698","article-title":"Chlorhexidine gluconate 0.2% as a treatment for recalcitrant fungal keratitis in Uganda: a pilot study","volume":"6","author":"Arunga","year":"2021","journal-title":"BMJ Open Ophthalmol"},{"key":"R51-20260610","doi-asserted-by":"crossref","first-page":"1532289","DOI":"10.3389\/fcimb.2025.1532289","article-title":"Antifungal susceptibility and clinical efficacy of chlorhexidine combined with topical ophthalmic medications against Fusarium species isolated from corneal samples","volume":"15","author":"Kang","year":"2025","journal-title":"Front Cell Infect Microbiol"},{"key":"R52-20260610","first-page":"562","article-title":"Current applications and prospects of nanoparticles for antifungal drug delivery","volume":"20","author":"Nami","year":"2021","journal-title":"EXCLI J"},{"key":"R53-20260610","doi-asserted-by":"crossref","first-page":"1440065","DOI":"10.3389\/fmicb.2024.1440065","article-title":"Advances in silver nanoparticles: a comprehensive review on their potential as antimicrobial agents and their mechanisms of action elucidated by proteomics","volume":"15","author":"Rodrigues","year":"2024","journal-title":"Front Microbiol"},{"key":"R54-20260610","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1089\/jop.2012.0155","article-title":"In vitro antifungal activity of silver nanoparticles against ocular pathogenic filamentous fungi","volume":"29","author":"Xu","year":"2013","journal-title":"J Ocul Pharmacol Ther"},{"key":"R55-20260610","doi-asserted-by":"crossref","first-page":"5090","DOI":"10.1021\/acsbiomaterials.1c00815","article-title":"Antimicrobial Action of Biocompatible Silver Microspheres and Their Role in the Potential Treatment of Fungal Keratitis","volume":"7","author":"Shi","year":"2021","journal-title":"ACS Biomater Sci Eng"},{"key":"R56-20260610","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1016\/j.nano.2015.12.378","article-title":"Amphotericin B-silver hybrid nanoparticles: synthesis, properties and antifungal activity","volume":"12","author":"Tutaj","year":"2016","journal-title":"Nanomedicine"},{"key":"R57-20260610","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1007\/s10123-018-00043-3","article-title":"Combination Therapy of Clinically Approved Antifungal Drugs Is Enhanced by Conjugation with Silver Nanoparticles","volume":"22","author":"Hussain","year":"2019","journal-title":"Int Microbiol"},{"key":"R58-20260610","doi-asserted-by":"crossref","first-page":"212771","DOI":"10.1016\/j.bioadv.2022.212771","article-title":"Drug-loaded mesoporous carbon with sustained drug release capacity and enhanced antifungal activity to treat fungal keratitis","volume":"136","author":"Gu","year":"2022","journal-title":"Biomater Adv"},{"key":"R59-20260610","first-page":"1568","article-title":"A Mussel-Inspired Facile Method to Prepare Multilayer-AgNP-Loaded Contact Lens for Early Treatment of Bacterial and Fungal Keratitis","volume":"4","author":"Liu","year":"2018","journal-title":"ACS Biomater Sci Eng"},{"key":"R60-20260610","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/j.jds.2023.07.007","article-title":"In vitro cytotoxicity and antibacterial activity of hypochlorous acid antimicrobial agent","volume":"19","author":"Tsai","year":"2024","journal-title":"J Dent Sci"},{"key":"R61-20260610","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1167\/tvst.12.8.3","article-title":"0.01% Hypochlorous Acid Treats Aspergillus fumigatus Keratitis in Rats by Reducing Fungal Load and Inhibiting the Inflammatory Response","volume":"12","author":"Zhao","year":"2023","journal-title":"Transl Vis Sci Technol"},{"key":"R62-20260610","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1080\/02713683.2023.2226374","article-title":"Evaluation of 0.01% Hypochlorous Acid Eye Drops Combined with Conventional Treatment in the Management of Fungal Corneal Ulcers: Randomized Controlled Trial","volume":"48","author":"Wang","year":"2023","journal-title":"Curr Eye Res"},{"key":"R63-20260610","doi-asserted-by":"crossref","first-page":"1895","DOI":"10.2147\/IDR.S399715","article-title":"Clinical Observation of Low-Temperature Plasma Ablation Combined with Drug Therapy in the Treatment of Fungal Keratitis","volume":"16","author":"Sun","year":"2023","journal-title":"Infect Drug Resist"},{"key":"R64-20260610","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1080\/09273948.2022.2060839","article-title":"Clinical Investigation of the Safety and Efficacy of Low-temperature Plasma as an Adjuvant Treatment for Mild to Moderate Fungal Keratitis: A Pilot Study","volume":"31","author":"Cheng","year":"2023","journal-title":"Ocul Immunol Inflamm"},{"key":"R65-20260610","doi-asserted-by":"crossref","first-page":"e02505","DOI":"10.1128\/AAC.02505-18","article-title":"Natamycin and Voriconazole Exhibit Synergistic Interactions with Nonantifungal Ophthalmic Agents against Fusarium Species Ocular Isolates","volume":"63","author":"Rees","year":"2019","journal-title":"Antimicrob Agents Chemother"},{"key":"R66-20260610","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1001\/jamaophthalmol.2017.0616","article-title":"Mycotic Ulcer Treatment Trial Group. Adjunctive Oral Voriconazole Treatment of Fusarium Keratitis: A Secondary Analysis From the Mycotic Ulcer Treatment Trial II","volume":"135","author":"Prajna","year":"2017","journal-title":"JAMA Ophthalmol"},{"key":"R67-20260610","doi-asserted-by":"crossref","first-page":"922","DOI":"10.3390\/microorganisms12050922","article-title":"Efficacy of the Combined Intrastromal Injection of Voriconazole and Amphotericin B in Recalcitrant Fungal Keratitis","volume":"12","author":"Moramarco","year":"2024","journal-title":"Microorganisms"},{"key":"R68-20260610","doi-asserted-by":"crossref","first-page":"116806","DOI":"10.1016\/j.diagmicrobio.2025.116806","article-title":"Investigating the susceptibility profiles and in vitro combinations of caspofungin, itraconazole, fluconazole, voriconazole, clotrimazole, and amphotericin B against clinical isolates causing fungal keratitis","volume":"112","author":"Moghadam","year":"2025","journal-title":"Diagn Microbiol Infect Dis"},{"key":"R69-20260610","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1128\/AAC.46.1.245-247.2002","article-title":"In vitro synergy of caspofungin and amphotericin B against Aspergillus and Fusarium spp","volume":"46","author":"Arikan","year":"2002","journal-title":"Antimicrob Agents Chemother"},{"key":"R70-20260610","doi-asserted-by":"crossref","first-page":"e00399","DOI":"10.1128\/AAC.00399-19","article-title":"Echinocandins for the Treatment of Invasive Aspergillosis: from Laboratory to Bedside","volume":"63","author":"Aruanno","year":"2019","journal-title":"Antimicrob Agents Chemother"},{"key":"R71-20260610","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.3390\/jof8101077","article-title":"Antifungal Combinations against Candida Species: From Bench to Bedside","volume":"8","author":"Fioriti","year":"2022","journal-title":"J Fungi (Basel)"},{"key":"R72-20260610","first-page":"1884","article-title":"Effect of topical application of terbinafine on fungal keratitis","volume":"122","author":"Liang","year":"2009","journal-title":"Chin Med J (Engl)"},{"key":"R73-20260610","doi-asserted-by":"crossref","first-page":"12","DOI":"10.17116\/oftalma202313904112","article-title":"Eksperimental'noe izuchenie effektivnosti terbinafina v lechenii gribkovykh keratitov [Experimental study of the effectiveness of terbinafine in the treatment of fungal keratitis","volume":"139","author":"Davletshina","year":"2023","journal-title":"Vestn Oftalmol"},{"key":"R74-20260610","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1080\/mmy.39.1.91.95","article-title":"Synergistic interaction of terbinafine with triazoles or amphotericin B against Aspergillus species","volume":"39","author":"Ryder","year":"2001","journal-title":"Med Mycol"},{"key":"R75-20260610","doi-asserted-by":"crossref","first-page":"1521","DOI":"10.1097\/ICO.0000000000001365","article-title":"Comparison of Oral Voriconazole Versus Oral Ketoconazole as an Adjunct to Topical Natamycin in Severe Fungal Keratitis: A Randomized Controlled Trial","volume":"36","author":"Sharma","year":"2017","journal-title":"Cornea"},{"key":"R76-20260610","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":"R77-20260610","doi-asserted-by":"crossref","first-page":"2437","DOI":"10.2147\/OPTH.S301878","article-title":"Comparison of Safety and Efficacy of Intrastromal Injections of Voriconazole, Amphotericin B and Natamycin in Cases of Recalcitrant Fungal Keratitis: A Randomized Controlled Trial","volume":"15","author":"Saluja","year":"2021","journal-title":"Clin Ophthalmol"},{"key":"R78-20260610","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1016\/j.ophtha.2021.12.004","article-title":"Topical Chlorhexidine 0.2% versus Topical Natamycin 5% for the Treatment of Fungal Keratitis in Nepal: A Randomized Controlled Noninferiority Trial","volume":"129","author":"Hoffman","year":"2022","journal-title":"Ophthalmology"},{"key":"R79-20260610","doi-asserted-by":"crossref","first-page":"e114386","DOI":"10.1371\/journal.pone.0114386","article-title":"Tacrolimus (FK506) suppresses TREM-1 expression at an early but not at a late stage in a murine model of fungal keratitis","volume":"9","author":"Huang","year":"2014","journal-title":"PLoS One"},{"key":"R80-20260610","doi-asserted-by":"crossref","first-page":"1538","DOI":"10.1097\/ICO.0000000000003934","article-title":"Adjunctive Topical Calcineurin Inhibitors During the Treatment of Fungal Keratitis: Practice Patterns and Opinions","volume":"44","author":"Christy","year":"2025","journal-title":"Cornea"},{"key":"R81-20260610","first-page":"187","article-title":"Tacrolimus interacts with voriconazole to reduce the severity of fungal keratitis by suppressing IFN-related inflammatory responses and concomitant FK506 and voriconazole treatment suppresses fungal keratitis","volume":"24","author":"Zhong","year":"2018","journal-title":"Mol Vis"},{"key":"R82-20260610","first-page":"305","article-title":"[The observation of tacrolimus eye drops preventing the early immunological rejection after penetrating keratoplasty for fungal keratitis","volume":"53","author":"Xiang","year":"2017","journal-title":"Zhonghua Yan Ke Za Zhi"},{"key":"R83-20260610","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1080\/02713680902866980","article-title":"Cyclosporin A eye drops inhibit fibrosis and inflammatory cell infiltration in murine type I allergic conjunctivitis without affecting the early-phase reaction","volume":"34","author":"Shii","year":"2009","journal-title":"Curr Eye Res"},{"key":"R84-20260610","first-page":"392","article-title":"The immunomodulatory effect of topical cyclosporin A in atopic keratoconjunctivitis","volume":"40","author":"Hingorani","year":"1999","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"R85-20260610","doi-asserted-by":"crossref","first-page":"974","DOI":"10.12669\/pjms.40.5.7777","article-title":"Clinical efficacy of cyclosporin and natamycin for fungal keratitis","volume":"40","author":"Yang","year":"2024","journal-title":"Pak J Med Sci"},{"key":"R86-20260610","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1097\/ICO.0000000000002827","article-title":"Use of Topical Cyclosporine 0.1% in Therapeutic Penetrating Keratoplasty for Fungal Keratitis","volume":"41","author":"Chatterjee","year":"2022","journal-title":"Cornea"},{"key":"R87-20260610","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1097\/00003226-200203000-00006","article-title":"Topical cyclosporin A in the management of therapeutic keratoplasty for mycotic keratitis","volume":"21","author":"Perry","year":"2002","journal-title":"Cornea"},{"key":"R88-20260610","doi-asserted-by":"crossref","first-page":"124593","DOI":"10.1016\/j.ijpharm.2024.124593","article-title":"Synergistic antifungal activity against Candida albicans between voriconazole and cyclosporine a loaded in polymeric nanoparticles","volume":"664","author":"Mart\u00edn","year":"2024","journal-title":"Int J Pharm"},{"key":"R89-20260610","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.molimm.2022.04.007","article-title":"The therapeutic potential of chondroitin sulfate in Aspergillus fumigatus keratitis","volume":"147","author":"Luan","year":"2022","journal-title":"Mol Immunol"},{"key":"R90-20260610","doi-asserted-by":"crossref","first-page":"135290","DOI":"10.1016\/j.ijbiomac.2024.135290","article-title":"Multifunctional natamycin modified chondroitin sulfate eye drops with anti-inflammatory, antifungal and tissue repair functions possess therapeutic effects on fungal keratitis in mice","volume":"279","author":"Tian","year":"2024","journal-title":"Int J Biol Macromol"},{"key":"R91-20260610","doi-asserted-by":"crossref","first-page":"7847","DOI":"10.1039\/D2TB00114D","article-title":"Oxidized chondroitin sulfate eye drops ameliorate the prognosis of fungal keratitis with anti-inflammatory and antifungal effects","volume":"10","author":"Tian","year":"2022","journal-title":"J Mater Chem B"},{"key":"R92-20260610","first-page":"183","article-title":"Role of vasoactive intestinal peptide in Aspergillus fumigatus-infected cornea","volume":"11","author":"Li","year":"2018","journal-title":"Int J Ophthalmol"},{"key":"R93-20260610","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.intimp.2019.01.032","article-title":"Maresin1 regulates neutrophil recruitment and IL-10 expression in Aspergillus fumigatus keratitis","volume":"69","author":"Tang","year":"2019","journal-title":"Int Immunopharmacol"},{"key":"R94-20260610","first-page":"536","article-title":"Rapamycin liposome gutta inhibiting fungal keratitis of rats","volume":"12","author":"Zhang","year":"2019","journal-title":"Int J Ophthalmol"},{"key":"R95-20260610","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1167\/iovs.61.2.25","article-title":"The Role of Autophagy in the Innate Immune Response to Fungal Keratitis Caused by Aspergillus fumigatus Infection","volume":"61","author":"Li","year":"2020","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"R96-20260610","doi-asserted-by":"crossref","first-page":"2669","DOI":"10.1128\/IAI.00179-13","article-title":"Protective role of murine \u03b2-defensins 3 and 4 and cathelin-related antimicrobial peptide in Fusarium solani keratitis","volume":"81","author":"Kolar","year":"2013","journal-title":"Infect Immun"},{"key":"R97-20260610","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.imbio.2013.10.003","article-title":"Induction of innate immunity by Aspergillus fumigatus cell wall polysaccharides is enhanced by the composite presentation of chitin and beta-glucan","volume":"219","author":"Dubey","year":"2014","journal-title":"Immunobiology"},{"key":"R98-20260610","doi-asserted-by":"crossref","first-page":"2948","DOI":"10.1167\/iovs.17-21476","article-title":"ISG15 in Host Defense Against Candida albicans Infection in a Mouse Model of Fungal Keratitis","volume":"58","author":"Dong","year":"2017","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"R99-20260610","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1186\/s12886-025-04038-3","article-title":"Corneal cross-linking for infectious keratitis of various causes: an umbrella review","volume":"25","author":"Farhadi","year":"2025","journal-title":"BMC Ophthalmol"},{"key":"R100-20260610","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1016\/j.jtos.2019.08.006","article-title":"Photoactivated chromophore for infectious keratitis - Corneal cross-linking (PACK-CXL): A systematic review and meta-analysis","volume":"17","author":"Ting","year":"2019","journal-title":"Ocul Surf"},{"key":"R101-20260610","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1186\/s13643-023-02380-5","article-title":"Photoactivated chromophore-corneal cross-linking accelerates corneal healing in fungal keratitis: an updated meta-analysis","volume":"12","author":"Liu","year":"2023","journal-title":"Syst Rev"},{"key":"R102-20260610","doi-asserted-by":"crossref","first-page":"1443","DOI":"10.1007\/s00417-019-04314-1","article-title":"Evaluation of corneal cross-linking as adjuvant therapy for the management of fungal keratitis","volume":"257","author":"Wei","year":"2019","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"R103-20260610","doi-asserted-by":"crossref","first-page":"78","DOI":"10.3928\/1081597X-20201123-02","article-title":"Corneal Cross-linking at the Slit Lamp","volume":"37","author":"Hafezi","year":"2021","journal-title":"J Refract Surg"},{"key":"R104-20260610","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.ajo.2015.03.024","article-title":"Corneal Cross-linking as an Adjuvant Therapy in the Management of Recalcitrant Deep Stromal Fungal Keratitis: A Randomized Trial","volume":"160","author":"Uddaraju","year":"2015","journal-title":"Am J Ophthalmol"},{"key":"R105-20260610","doi-asserted-by":"crossref","first-page":"2011","DOI":"10.3390\/pharmaceutics13122011","article-title":"Recent Advances in Photodynamic Therapy against Fungal Keratitis","volume":"13","author":"Hung","year":"2021","journal-title":"Pharmaceutics"},{"key":"R106-20260610","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.ajo.2014.04.007","article-title":"Assessment of rose bengal versus riboflavin photodynamic therapy for inhibition of fungal keratitis isolates","volume":"158","author":"Arboleda","year":"2014","journal-title":"Am J Ophthalmol"},{"key":"R107-20260610","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1080\/02713683.2022.2058019","article-title":"Clinical Outcomes of Rose Bengal Mediated Photodynamic Antimicrobial Therapy on Fungal Keratitis with Their Microbiological and Pathological Correlation","volume":"47","author":"Bagga","year":"2022","journal-title":"Curr Eye Res"},{"key":"R108-20260610","doi-asserted-by":"crossref","first-page":"6286","DOI":"10.1167\/iovs.10-6935","article-title":"A prototype antifungal contact lens","volume":"52","author":"Ciolino","year":"2011","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"R109-20260610","doi-asserted-by":"crossref","first-page":"1164","DOI":"10.1016\/S0022-3549(15)00193-8","article-title":"Controlled Release of Antibiotics From Vitamin E-Loaded Silicone-Hydrogel Contact Lenses","volume":"105","author":"Paradiso","year":"2016","journal-title":"J Pharm Sci"},{"key":"R110-20260610","doi-asserted-by":"crossref","first-page":"6464","DOI":"10.1021\/acsnano.6b00601","article-title":"A Hydrogel-Based Hybrid Theranostic Contact Lens for Fungal Keratitis","volume":"10","author":"Huang","year":"2016","journal-title":"ACS Nano"},{"key":"R111-20260610","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1016\/j.actbio.2021.04.014","article-title":"Contact lenses coated with hybrid multifunctional ternary nanocoatings (Phytomolecule-coated ZnO nanoparticles: Gallic Acid: Tobramycin) for the treatment of bacterial and fungal keratitis","volume":"128","author":"Khan","year":"2021","journal-title":"Acta Biomater"},{"key":"R112-20260610","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1080\/02713683.2019.1708407","article-title":"Infectious Keratitis Caused by Rare and Emerging Micro-Organisms","volume":"45","author":"Sahay","year":"2020","journal-title":"Curr Eye Res"},{"issue":"7","key":"R113-20260610","doi-asserted-by":"crossref","first-page":"866","DOI":"10.1097\/ICO.0000000000003675","article-title":"Temporary Conjunctival Flap Plus Medical Treatment Versus Medical Treatment Only for High-Risk Fungal Keratitis: A Randomized Controlled Trial","volume":"44","author":"Khalil","year":"2024","journal-title":"Cornea"},{"key":"R114-20260610","doi-asserted-by":"crossref","first-page":"1639","DOI":"10.1007\/s00417-022-05969-z","article-title":"Continuous voriconazole lavage in managing moderate and severe fungal keratitis: a randomized controlled trial","volume":"261","author":"Gong","year":"2023","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"R115-20260610","doi-asserted-by":"crossref","first-page":"1544","DOI":"10.1097\/ICO.0000000000003251","article-title":"Randomized Double-Masked Placebo-Controlled Trial for the Management of Pythium Keratitis: Combination of Antibiotics Versus Monotherapy","volume":"42","author":"Tanna","year":"2023","journal-title":"Cornea"},{"key":"R116-20260610","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/j.jtos.2025.09.001","article-title":"Predictors of vision-related quality of life in patients treated for filamentous fungal keratitis","volume":"38","author":"Prajna","year":"2025","journal-title":"Ocul Surf"},{"key":"R117-20260610","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1097\/ICO.0000000000002965","article-title":"Mediators of the Effect of Corneal Cross-Linking on Visual Acuity for Fungal Ulcers: A Prespecified Secondary Analysis From the Cross-Linking-Assisted Infection Reduction Trial","volume":"41","author":"Prajna","year":"2022","journal-title":"Cornea"}],"container-title":["Saudi Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/sjopt.sjopt_492_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:05:24Z","timestamp":1787760324000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/sjopt.sjopt_492_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":117,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/sjopt.sjopt_492_25","relation":{},"ISSN":["1319-4534","2542-6680"],"issn-type":[{"value":"1319-4534","type":"print"},{"value":"2542-6680","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]},"assertion":[{"value":"2025-12-17","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-04","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}