**4.6 Echinocandins**

Echinocandins (caspofungin and micafungin) are semisynthetic lipopeptides act by inhibiting the synthesis of glucan in the fungal cell wall causing osmotic imbalance and cell lysis. Matsumoto et al. have reported successful use of topical 0.2% micafungin in cases of refractory fungal keratitis [92]. In another study by Matsumoto et al. usiing topical micafungin 1 mg/ml reported found an efficacy comparable or superior to fluconazole in the treatment of keratitis by *Candida albicans* and *Candida parapsilosis* [93]. Topical caspofungin has been used in the cases of fungal keratitis refractory to voriconazole [94]. There are limited data on the use of echinocandins to treat fungal keratitis in humans.
