Successful treatment of Fusarium keratitis after photo refractive keratectomy
A 39-year-old woman presented to our hospital with a history of photorefractive keratectomy (PRK), performed two weeks prior. She complained severe visual loss, photophobia, redness and pain in right eye.\nThe patient was receiving therapy with topical steroids and antibiotic eye drops. The best corrected visual acuity (BCVA) of the affected eye was limited to hand motion. Slit lamp examinations revealed diffuse conjunctival congestion and a corneal ulcer with stromal infiltration [].\nThe ulcer bed and edges were scraped and were sent for bacteriological and mycological examination analysis.\nTreatment with corticosteroid eye drops was suspended and the patient was started on the following drugs: Topical fortified 5% vancomicin, tobramicin 0.3%, moxifloxacin 0.5%, amphotericin B 0.15% at 4 h intervals; systemic antifungal and antibacteric drugs consisted of oral itraconazole at a dose of 200 mg daily with oral ciprofloxacin 1g daily, and intramuscolar ceftriaxone 1 g daily respectively.\nAfter two days the cornea revealed a full thickness infiltrate with 1 mm hypopyon []. The infiltrate and the hypopyon progressively increased in size. After 5 days, the patient underwent a therapeutic penetrating keratoplasty with an 8-mm graft on a 7.75-mm bed using Barron Corneal Trephine. The explanted cornea was sent to the microbiology laboratory for further testing.\nPost-surgery treatment consisted in topical norfloxacin 0.3% (6 times per day) and amphotericin B (4 times per day); systemic ciprofloxacin 1 g daily, ceftriaxone 1 g daily, itraconazole 200 mg daily and intramuscolar metilprednisolone 20 mg daily [].\nAfter 8 days, the culture of corneal scraping revealed the presence of fungal filaments. We decided in agreement with the infectious disease specialist, to add therapy with oral voriconazole, (800 mg per day on the first day, followed by 400 mg per day on successive days) and topical amphothericin B eye drops 6 times per day. The donor cornea and anterior chamber remained free from infiltrates until day 12, after keratoplasty, when the patient showed eye redness, pain, 1/50 of visual acuity, endothelial dusting and aqueous flare and cells [Figs. and ]. Oral voriconazole was changed to intravenous formulation, 8 mg/Kg twice per day.\nTwenty days after surgery the patient had recurrent fungal infiltrate in the donor cornea with wound dehiscence []. We decided to perform a second penetrating keratoplasty.