J Korean Ophthalmol Soc.  2008 Oct;49(10):1680-1684.

A Case of Fungal Keratitis Treated with Voriconazole

• Yoon JU
• Kim SW
• Ha BJ
• Kim TI
• Kim EK

Abstract

PURPOSE
To report drug-resistant fungal keratitis that was treated with voriconazole.
CASE SUMMARY
A 31-year-old man was admitted to hospital because of ocular pain, conjunctival injection, and visual weakness 7 days after LASIK surgery. At that time, his vision was counting finger at 30 cm and he presented with corneal epithelial defects, stromal infiltration, and inflammation in the anterior chamber of his eye. He was transferred to our hospital because his infection was resistant to gatifloxacin, tobramycin, amphotericin B, and natamycin eyedrops. At the time of transfer, his vision was counting finger at 30 cm and he presented with corneal epithelial defects, stromal infiltration, and hypopyon. He was treated with topical 2% voriconazole every 2 hours and the lesion improved. However, the hypopyon recurred after 12 days. He was then treated with intracameral voriconazole injection (50 microgram/0.1 cc) and topical 5% voriconazole every hour causing the hypopyon to disappear. His vision improved from counting finger to 20/40 six months after this treatment.

Keyword

Fungal keratitis; LASEK; Pseudoallescheria boydii; Voriconazole

MeSH Terms

Adult
Amphotericin B
Anterior Chamber
Eye
Fingers
Fluoroquinolones
Humans
Inflammation
Keratectomy, Subepithelial, Laser-Assisted
Keratitis
Keratomileusis, Laser In Situ
Natamycin
Ophthalmic Solutions
Pyrimidines
Tobramycin
Triazoles
Vision, Ocular
Amphotericin B
Fluoroquinolones
Natamycin
Ophthalmic Solutions
Pyrimidines
Tobramycin
Triazoles

Figure

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  Figure 1. On the first day the patient visited our clinic, infiltration was mainly located in the center of the cornea and hypopyon was noted.

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  Figure 2. On day 4 after hospitalization, the margin of the lesion became clear and the size decreased. Also hypopyon had disappeared.

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  Figure 3. On day 15 after hospitalization, before the intracameral injection of Voriconazole, hypopyon reappeared.

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  Figure 4. At 3 months after intracameral voriconazole injection, there is central corneal opacity with resolution hypopyon and infiltration is noted.

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