Successful treatment of Fusarium keratitis after photo refractive keratectomy

• Main Authors: Gian Maria Cavallini, Pietro Ducange, Veronica Volante, Caterina Benatti
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2013-01-01
• Series: Indian Journal of Ophthalmology
• Subjects: Anterior segment parameter; pars plana vitrectomy; pentacam; silicone oil injection; Astigmatism; cataract surgery; toric lens; toric intraocular lens; Amblyopia; anisometropia; occlusion; recurrence; visual acuity; Cortical visual impairment; flash visual evoked potentials; periventricular leucomalacia; stimulation frequency in visual evoked potentials; visual evoked potentials; Cytomegalovirus retinitis; cytomegalovirus retinitis retinal detachment; cytomegalovirus; highly active antiretroviral therapy; Incidence; postnatal weight gain; retinopathy of prematurity; risk factors; weight gain proportion; Nasal incision; surgically induced astigmatism; temporal incision; Mantoux test; serpiginous choroiditis; tuberculosis; Distortion; epiretinal membrane; macular hole; metamorphopsia; morphision; Complication; phacoemulsifi cation learning curve; resident training; Choroidal metastases; lung adenocarcinoma; Spectral Domain OCT; Calcified heart valve; emboli; internal carotid artery plaque; Fusarium; keratitis; photo refractive keratectomy
• Online Access: http://www.ijo.in/article.asp?issn=0301-4738;year=2013;volume=61;issue=11;spage=669;epage=671;aulast=Cavallini

A 39-year-old woman presented to our hospital with a history of photorefractive keratectomy (PRK), performed two weeks prior; slit-lamp examination revealed diffuse conjunctival congestion, corneal ulcer and stromal infiltration. After 5 days of antifungal and antibacteric treatment, the infiltrate progressively increased so that a therapeutic penetrating keratoplasty was necessary. The microbiological analyses revealed the presence of fungal filaments. Twenty days after surgery the patient had recurrent fungal infiltrate in the donor cornea with wound dehiscence. We performed a second penetrating keratoplasty. With the matrix-assisted-laser-desorption-ionization-time-of-flight analysis (MALDI-TOF) we identified a Fusarium solani.Intravenous amphothericine B, a combination of intracameral and intrastromal voriconazole and intracameral amphotericine B were administered. After 6 months from the last surgery the infection was eradicated. The management of fungal keratitis after PRK depends on many factors: In our experience, a prompt keratoplasty and the use of intracameral antifungal medication proved to be very effective.