Adjunctive Topical Calcineurin Inhibitors During the Treatment of Fungal Keratitis: Practice Patterns and Opinions

Purpose: Successful antifungal treatment for fungal keratitis does not always result in a good visual outcome. Both infectious and inflammatory components of the disease result in visually significant corneal opacification. We conducted a survey of cornea specialists to elicit expert opinion on the role topical calcineurin inhibitors may play in the management of fungal keratitis. Methods: An online survey was sent to subscribers of several cornea-focused listservs. Descriptive statistics were performed. Results: One hundred thirty-five participants completed the online survey. Approximately 48% of respondents practiced medicine in the United States and 36% in India. About 23% presently “sometimes” prescribe topical calcineurin inhibitors. And 70% never prescribe. When administered adjunctively to topical antifungal drops, 59% of respondents predict 1% to 2% topical cyclosporin would have a clinically significant antiinflammatory effect compared with 33% for the 0.05% to 0.1% cyclosporin dose. About 50% believe the 0.1% tacrolimus dose would have a clinically significant antiinflammatory activity compared with the 0.03% tacrolimus dose. Overall, those surveyed predicted adjunctive topical calcineurin inhibitors could improve final visual acuity by almost one line of vision. Conclusions: Varied opinions exist regarding the role adjunctive topical calcineurin inhibitors can play during a treatment course of fungal keratitis. The overall impression is that these agents may help clinical outcome.