Intrastromal Injections in the Management of Infectious Keratitis
Infectious keratitis is a major global cause of vision loss and blindness. Prompt diagnosis and targeted antibiotic treatment are crucial for managing the condition. Topical antimicrobials are the most effective therapy for bacterial keratitis, but they can lead to unsatisfactory results due to ocul...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-03-01
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| Series: | Pharmaceutics |
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| Online Access: | https://www.mdpi.com/1999-4923/15/4/1091 |
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| author | Mihail Zemba Madalina Radu Sinziana Istrate Otilia-Maria Dumitrescu Mihai Alexandru Ionescu Andrei Vatafu Ileana Ramona Barac |
| author_facet | Mihail Zemba Madalina Radu Sinziana Istrate Otilia-Maria Dumitrescu Mihai Alexandru Ionescu Andrei Vatafu Ileana Ramona Barac |
| author_sort | Mihail Zemba |
| collection | DOAJ |
| description | Infectious keratitis is a major global cause of vision loss and blindness. Prompt diagnosis and targeted antibiotic treatment are crucial for managing the condition. Topical antimicrobials are the most effective therapy for bacterial keratitis, but they can lead to unsatisfactory results due to ocular perforation, scarring, and melting. Intrastromal injection is a newer technique for delivering antimicrobials directly to the site of infection and has been successful in treating severe, treatment-resistant infectious keratitis, especially when surgery is not recommended. In cases where deep stromal disease is resistant to topical treatment, intrastromal antimicrobial injections may be necessary to achieve higher drug concentration at the infection site. However, the use of intrastromal antibiotics is limited, as topical antibacterial agents have better penetration than antifungal agents. Bacterial and fungal keratitis have been extensively researched for intrastromal medication injections, while there is limited evidence for viral keratitis. This review emphasizes the potential of intrastromal antimicrobial injections as an alternative for managing severe refractory infectious keratitis. The technique offers direct targeting of the infection site and faster resolution in some cases compared to topical therapy. However, further research is needed to determine the safest antimicrobials options, minimal effective doses, and concentrations for various pathogens. Intrastromal injections may serve as a non-surgical treatment option in high-risk cases, with benefits including direct drug delivery and reduced epithelial toxicity. Despite promising findings, more studies are required to confirm the safety and efficacy of this approach. |
| first_indexed | 2024-03-11T04:38:41Z |
| format | Article |
| id | doaj.art-da393ea47ae6457faa02d3c599fcdb41 |
| institution | Directory Open Access Journal |
| issn | 1999-4923 |
| language | English |
| last_indexed | 2024-03-11T04:38:41Z |
| publishDate | 2023-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Pharmaceutics |
| spelling | doaj.art-da393ea47ae6457faa02d3c599fcdb412023-11-17T20:52:35ZengMDPI AGPharmaceutics1999-49232023-03-01154109110.3390/pharmaceutics15041091Intrastromal Injections in the Management of Infectious KeratitisMihail Zemba0Madalina Radu1Sinziana Istrate2Otilia-Maria Dumitrescu3Mihai Alexandru Ionescu4Andrei Vatafu5Ileana Ramona Barac6Department of Ophthalmology, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, RomaniaDepartment of Ophthalmology, “Dr. Carol Davila” Central Military Emergency University Hospital, 010825 Bucharest, RomaniaDepartment of Ophthalmology, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, RomaniaDepartment of Ophthalmology, “Dr. Carol Davila” Central Military Emergency University Hospital, 010825 Bucharest, RomaniaDepartment of Ophthalmology, “Dr. Carol Davila” Central Military Emergency University Hospital, 010825 Bucharest, RomaniaDepartment of Ophthalmology, “Dr. Carol Davila” Central Military Emergency University Hospital, 010825 Bucharest, RomaniaDepartment of Ophthalmology, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, RomaniaInfectious keratitis is a major global cause of vision loss and blindness. Prompt diagnosis and targeted antibiotic treatment are crucial for managing the condition. Topical antimicrobials are the most effective therapy for bacterial keratitis, but they can lead to unsatisfactory results due to ocular perforation, scarring, and melting. Intrastromal injection is a newer technique for delivering antimicrobials directly to the site of infection and has been successful in treating severe, treatment-resistant infectious keratitis, especially when surgery is not recommended. In cases where deep stromal disease is resistant to topical treatment, intrastromal antimicrobial injections may be necessary to achieve higher drug concentration at the infection site. However, the use of intrastromal antibiotics is limited, as topical antibacterial agents have better penetration than antifungal agents. Bacterial and fungal keratitis have been extensively researched for intrastromal medication injections, while there is limited evidence for viral keratitis. This review emphasizes the potential of intrastromal antimicrobial injections as an alternative for managing severe refractory infectious keratitis. The technique offers direct targeting of the infection site and faster resolution in some cases compared to topical therapy. However, further research is needed to determine the safest antimicrobials options, minimal effective doses, and concentrations for various pathogens. Intrastromal injections may serve as a non-surgical treatment option in high-risk cases, with benefits including direct drug delivery and reduced epithelial toxicity. Despite promising findings, more studies are required to confirm the safety and efficacy of this approach.https://www.mdpi.com/1999-4923/15/4/1091intrastromal injectionintracorneal injectionbacterial keratitisfungal keratitisviral keratitismicrobial keratitis |
| spellingShingle | Mihail Zemba Madalina Radu Sinziana Istrate Otilia-Maria Dumitrescu Mihai Alexandru Ionescu Andrei Vatafu Ileana Ramona Barac Intrastromal Injections in the Management of Infectious Keratitis Pharmaceutics intrastromal injection intracorneal injection bacterial keratitis fungal keratitis viral keratitis microbial keratitis |
| title | Intrastromal Injections in the Management of Infectious Keratitis |
| title_full | Intrastromal Injections in the Management of Infectious Keratitis |
| title_fullStr | Intrastromal Injections in the Management of Infectious Keratitis |
| title_full_unstemmed | Intrastromal Injections in the Management of Infectious Keratitis |
| title_short | Intrastromal Injections in the Management of Infectious Keratitis |
| title_sort | intrastromal injections in the management of infectious keratitis |
| topic | intrastromal injection intracorneal injection bacterial keratitis fungal keratitis viral keratitis microbial keratitis |
| url | https://www.mdpi.com/1999-4923/15/4/1091 |
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