Topical Caspofungin 0.5% Monotherapy for Filamentous Fungal Keratitis

Purpose: To describe a case series of patients with 12 fungal keratitis treated with caspofungin 0.5% eye drops. Methods: In this study, 12 patients diagnosed with fungal keratitis were treated with topical compounded caspofungin 0.5% eye drops. The authors also reviewed the existing literature on topical caspofungin 0.5% for managing fungal keratitis. Results: The average age of the patients was 50.16 ± 13.74 years, and the average time to presentation was 9.66 ± 6 days from the onset of symptoms. Out of the 12 patients, 10 were males, and 2 were females. Three (25%) patients had infiltrates extending up to the mid-stromal level, whereas 9 (75%) had superficial infiltration. Topical caspofungin monotherapy successfully treated the fungal infection in 8 (66.6%) patients, whereas 4 patients required additional medication and/or surgical intervention. The average size of the infiltration was 3.44 ± 1.21 mm. The group that responded to treatment had better final visual acuity compared to the nonresponding group, with values of 0.41 ± 0.48 logarithm of the minimum angle of resolution and 1.39 ± 0.10 logarithm of the minimum angle of resolution (P-value = 0.023), respectively. Conclusions: Topical caspofungin 0.5% is a safe and effective treatment for selected cases of fungal keratitis. However, cases with larger or deeper initial infiltrates, or those caused by Fusarium infection, may not respond adequately to topical caspofungin monotherapy.