Intrastromal autologous buffy coat as an adjuvant therapy for fungal corneal ulcer: a case report of two cases.

Purpose: To report the hastened recovery of two nonresponding fungal corneal ulcer cases after using intrastromal injections of autologous buffy coat (a component of blood rich in leucocytes) as an adjuvant to topical antifungal therapy. Methods: Microbiologically proven non-responding cases (>2 weeks of treatment) of fungal corneal ulcers who visited the cornea specialty clinic of our hospital were explained the disease and adjuvant intrastromal autologous buffy coat treatment, which would be repeated if effective. Then, well-informed and written consent was obtained from the patients for the treatment. The study adhered to the tenets of the Declaration of Helsinki. An in vitro experiment was also carried out to prove the hypothesis by growing fungi on a donor button and injecting it with the buffy coat of a healthy volunteer. Results: The study showed immediate positive outcomes, with patients showing faster lesion resolution with decreasing lesion size, resolving hypopyon, and complete clinical recovery in both cases in less than seven days. Discussion: Intrastromal autologous buffy coat shows promise as an adjunct therapy for difficult fungal corneal ulcers, enhancing local immunity and healing. This approach may reduce treatment time and risks, though further studies are needed to confirm these findings. Conclusion: Intrastromal buffy coat for recalcitrant fungal ulcers is a promising treatment modality as it provides both local immunity and growth and repair stimulus to the diseased cornea. However, a long-term randomized control trial is needed to evaluate the results further.