Management Of Relapsing Fungal Endotheliitis.

 Long-term management of fungal endotheliitis.

 Ophthalmology Department, University Hospital of Alexandroupolis

A 64-year old male was referred to our clinic due to corneal ulcer of the left eye after injury with wooden material. Uncorrected visual acuity was 4/10 Snellen and IOP was normal. Slit lamp biomicroscopy revealed the presence of a whitish inflammatory lesion and smaller satellite lesions on the cornea with an intact epithelium. Anterior chamber reaction with hypopyon was present as well. Empirical treatment with topical vancomycin and ceftriaxone hourly and cyclopentolate 3 times a day was administered. Anterior segment optical coherence tomography set the suspicion of fungal endotheliitis. Subsequently, topical amphotericin B 4 times a day was added. The patient was discharged with 6/10 visual acuity and topical treatment with amphotericin B 4 times a day. 7 days later there was recurrence of the inflammation with a visual acuity of 2/10 and hypopyon. 4 injections of amphotericin B and 2 injections of Voriconazole were administered in the anterior chamber leading to improvement in the patient status. Since then the patient underwent 4 more intracameral injections of Voriconazole because of relapses. His clinical picture was stabilized 4 months after the diagnosis. One year later, after phacoemulsification surgery, he achieved visual acuity of 10/10.

 Isolated corneal endotheliitis is uncommon. The presence of cotton-wool or snowflake like keratic precipitates and the absence of epithelial defect and stromal infiltration can differentiate it from fungal keratitis. The injection of antifungal agents to the anterior chamber can offer beneficial results.