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First Author: T.Borges PORTUGAL
Co Author(s): V. Pinto Miranda M. Gomes L. Oliveira P. Torres
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To report radial keratotomy associated with intracorneal rings as potential risk factors for fungal keratitis.
Hospital de Santo António, Centro Hospitalar do Porto, Portugal.
A 37 years old female, healthy, with previous radial keratotomy of both eyes was referred to our department with low visual acuity of the right eye (OD). Best Corrected Visual Acuity (BCVA) of the OD was 20/100 and corneal topography showed corneal ectasia. After informed consent, the patient was submitted to the insertion of one keraring® intracorneal ring.
Immediately after surgery, BCVA of the OD was 20/40. 4 months after surgery the patient went to the emergency room with red eye. The BCAV was 20/63 and a corneal infiltrate near the ring at 6 hours was noticed at biomicroscopy. The patient was treated with topic antibiotics (levofloxacin and tobramycin), dexamethasone and artificial tears with no improvement. It was decided to remove the intracorneal ring that was sent to laboratory for culture. The patient started fortified antibiotics (ceftazidime, gentamicin and vancomycin), oral ciprofloxacin and empiric antifungal therapy (topic clotrimazole and oral voriconazole). There was no clinical improvement, and the patient maintained the infiltrate in the intracorneal tunnel. Some days after, the microbiological study revealed candida albicans infection. An intrastromal wash with clotrimazole was also tried, with no success. Finally, a penetrating keratoplasty (PK) was performed. Three months after PK, BCVA was 20/100, corneal transplant was transparent and the patient was free of symptoms.
Previous radial keratotomy is an additional risk factor for the development of fungal keratitis in intracorneal rings surgery. Current treatment methods frequently fail to treat this infection. The PK is usually the ideal method to treat nonhealing fungal keratitis.