Clinical experiences in fungal keratitis caused by Acremonium
A 78-year old man complaining of decreased vision in his left eye was referred to our clinic. He had been injured in this eye with vegetable matter. Slit-lamp biomicroscopy showed mild conjunctival injection and a peripheral corneal infiltrate was associated with an epithelial defect in the left eye (). Corneal smears showed hyphae. He was started on an hourly instillation of topical 0.5% moxifloxacin, 0.15% amphotericin B, 0.2% fluconazole, and oral fluconazole. After 2 days of therapy, the clinical feature of the left eye had worsened, with the appearance of new stromal infiltrates. Topical application of 5% natamycin was included in his treatment regime. Seven days later, Acremonium was isolated from corneal culture. Despite this treatment, the patient’s condition failed to improve and the cornea was melting around the limbus. The treatment was changed to topical 5% natamycin and 1% voriconazole, and oral voriconazole, 200 mg twice a day. After 13 days of therapy, the patient underwent conjunctival flap surgery due to a progressive thinning of the cornea. After surgery, the corneal lesion was improved and topical natamycin and voriconazole were gradually tapered. The final BCVA was 0.15, and there was no recurrence in the following 2 months ().