J Korean Ophthalmol Soc.  2015 Mar;56(3):438-442. 10.3341/jkos.2015.56.3.438.

A Case of Alternaria Species Infection after Corneal Tattooing

• Ghim WH
• Cho KJ

• KMID: 2339052
• DOI: http://doi.org/10.3341/jkos.2015.56.3.438

Abstract

PURPOSE
To report a case of successful treatment of Alternaria species infection after corneal tattooing using penetrating keratoplasty corneal perforation.
CASE SUMMARY
A 65-year-old male underwent corneal tattooing for corneal opacity of the left eye. One month later, epithelial defect and necrosis of the left eye were observed, thus a smear and culture were performed and Alternaria species were cultured. He was treated with 0.3% amphotericin B-fortified eyedrops and Itraconazole oral medication; however, 3 weeks later, corneal perforation of the left eye was observed and penetrating keratoplasty was performed. Postoperatively, due to persistent increased intraocular pressure, trabeculectomy was performed. Two months later, donor cornea was well-grafted and recurrent keratitis was not observed.
CONCLUSIONS
Corneal tattooing can cause damage to the corneal epithelium and anterior stroma and increase the risk of infection when using steroids. In the case of infection, detecting and differentiating the type of microorganisms are more difficult. Therefore, proper care and close monitoring for the signs of infection are important during and after the surgery.

Keyword

Alternaria; Corneal opacity; Corneal tattooing; Fungus; Penetrating keratoplasty

MeSH Terms

Aged
Alternaria*
Amphotericin B
Cornea
Corneal Opacity
Corneal Perforation
Epithelium, Corneal
Fungi
Humans
Intraocular Pressure
Itraconazole
Keratitis
Keratoplasty, Penetrating
Male
Necrosis
Ophthalmic Solutions
Steroids
Tattooing*
Tissue Donors
Trabeculectomy
Amphotericin B
Itraconazole
Ophthalmic Solutions
Steroids

Figure

• 

  Figure 1. Slit lamp investigation of the left eye before corneal tattooing revealed corneal opacity and calcium deposition (arrowhead) at center and black pigmentation of old tattooing at periphery (arrow).

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  Figure 2. (A) Slit lamp investigation of the left eye 43 days after corneal tattooing revealed epithelial defect and necrosis of cornea. (B) Slit lamp investigation of the left eye 64 days after corneal tattooing revealed corneal thinning and perforation.

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  Figure 3. Slit lamp investigation of the left eye 2 months after penetrating keratoplasty revealed a well-grafted cornea (A) and well-elevated filtering bleb (B). Recipient cornea was stained with black pigmentation (arrow).

Reference

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