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Impact of Iontophoresis and PACK-CXL Corneal Concentrations of Antifungals in an In Vivo Model

Yesilirmak, Nilufer
Ozdemir, Huseyin Baran
Unal, Elif Ayca
Erdogan, Merve
Şeker, Tamay
Tum, Atakan Emre
Karakus, Ahmet Kamil
Hizel, Kenan
Bilgihan, Kamil
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.