J Korean Ophthalmol Soc.  2010 Apr;51(4):606-610. 10.3341/jkos.2010.51.4.606.

A Case of Fusarium Deep Keratitis Following Scleral Graft

• Oh DH
• Kim JC
• Chun YS

• KMID: 2213406
• DOI: http://doi.org/10.3341/jkos.2010.51.4.606

Abstract

PURPOSE
To report a case of drug-resistant Fusarium deep keratitis following sclera graft.
CASE SUMMARY
A 48-year-old woman, who underwent excision of the pterygium nine years previous, received a scleral graft for scleromalacia and ocular pain. After surgery, due to melting of the scleral graft and the presence of Fusarium deep keratitis, she received surgical and intensive medical treatment including three intracameral injections of antifungal agent, administration of topical voriconazole 1%, scleral re-graft, autologous conjunctival graft, and amniotic membrane transplantation. Nevertheless, the patient's ocular condition deteriorated with increased hypopyon, corneal opacity, and perforation. Enucleation was ultimately performed.

Keyword

Fungal keratits; Fusarium; Intracameral Voriconazole

MeSH Terms

Amnion
Corneal Opacity
Female
Freezing
Fusarium
Humans
Keratitis
Middle Aged
Pterygium
Pyrimidines
Sclera
Transplants
Triazoles
Pyrimidines
Triazoles

Figure

• 

  Figure 1. (A) At the diagnosis, there was severe melting of scleral graft and its surrounding tissue with severe conjuncitval injection. Corneal ulcer spread out from the necrotic sclera. (B) 1×2 mm round soft whitish mass was observed behind the stromal infiltration.

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  Figure 2. Color photographs of progression. (A) At 3 days after treatment, corneal infiltration was stationary but 2×2mm whitish mass developed again. (B) At 7 days after treatment, increased corneal ulcer with immune ring and aggravated sclera melting were found. (C) At 13 days after treatment, dense corneal infilration with enlarged scleral melting (5×4 mm) was observed. (D) At 17 days after treatment, although scleral graft, autologous conjunctival graft, and amniotic membrane transplantation were performed but yellow necrotized corneal ulcer developed at total cornea.

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  Figure 3. At 10 days after culture of aqueous humor and sclera, Fusarium solani was cultured. (A) Orange colored colony with lighter periphery on Sabouraud's agar plate. (B) There are two types of sporulation; large, sickle shaped, multiseptated macroconidia and small, oval shaped, microconidia in clusters.

Reference

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