الفهرس 
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Abstract
The aim of this work is to evaluate of clinical corneal lesions related to contact lens with laboratory results of contact lens and corneal scrapes culture which lead to keratitis. The second aim is to evaluate safety and efficacy of voriconazole in treating resistant and deep fungal keratitis related to contact lens infections. In this study 100 cases were investigated both clinically and by smears and /or cultures. All patients were submitted to full history taking, complete ophthalmic examination and their data were collected and reported on the examination sheets. Each lens was divided into four parts by a sterile forceps and each part was cultured on Nutrient agar, Blood agar and MacConkey which were incubated at (37ºC) for identification of different types of bacteria, however Sabouraud’s dextrose agar plates (with gentamycin to avoid bacterial contamination ) for identification of different types of fungi. SDA plates were incubated at (25ºC) for 7 days. The corneal scrapings obtained was inoculated on transport medium containing nutrient broth then sent to laboratory to be directly inoculated either on a slide for direct fungal identification under high magnification by the microscope without stains or on culture media as SDA where the fungal growth on the SDA media was used to form a film stained with Giemsa and Gram stain for visualization of the different types of fungi microscopically. The obtained results clearly indicated that: 1. The most common fungal keratitis was A.flavus (37.5%) followed by Fusarium solani (25%). 2. Staphylococcus aureus (44.4%) was the most common bacterial keratitis. 3. In the present study sex distribution revealed that 59 cases were males while 41 cases were females. 4. The risk factors were presented in 62 cases, it was found that, ocular trauma (contact lens wearer) was the most frequent risk factor as it occurred in 24 cases. 5. Treatment of isolated bacteria and fungi was done by using different types of antibiotics and antifungals by agar disc diffusion method. 6. Screening of the efficacy of 23 types of antibiotics were made and the most effective antibiotics were ( Ampicillin, Chloramphenicol, Meropenem, Ciprofloxacin and Amikacin) 7. Screening of different antifungal agents fluconazole (150 mg), itraconazole (100 mg) and voriconazole (200 mg). 8. The results clearly indicated that fungal isolates were 100% sensitive to voriconazole. 9. On the other hand the resistance of fungal isolates to itraconazole was 90 % and for fluconazole was 40%. In our study we made a Screening of natural product efficacy (Honey) which have been used in the treatment of corneal lesions and compare it with antifungal (Voriconazole). Honey is used worldwide for the treatment of various ophthalmological conditions. The antimicrobial activity of honey are different from antibiotics, which destroy the bacteria’s cell membrane or inhibit intracellular metabolic pathways. Honey has been reported to have inhibitory effects on fungi. Pure honey inhibits fungal growth and diluted honey appears capable of inhibiting toxin production. Disc diffusion method was used to evaluate the antimicrobial activity of combination of antifungal drug (Vfend) with honey. The effect between the antifungal drug (voriconazole) and honey was considered to be synergistic by the increase of IZD inhibition zone diameter) from combined action compared to the average of IZD obtained from the single action of the two components. Recommendation 1- Pseudomonas, which was common among lens wearers is most often responsible for lens wearer keratitis. 2- The results indicate that contact lens wearer are more eye infections than non-wearers. 3- Early diagnosis and treatment of contact lens related corneal ulcers is important to prevent permanent visual loss. 4- Voriconazole may be a new promising therapy for fungal keratitis, topical voriconazole is very effective, recent and broad spectrum antifungal therapy that has proven its efficacy in treatment of fungal keratitis.