Chronic Corneal Ulcer As A Complication After Endophthalmitis, Manage And Treatment.

To report the clinical the presentation, etiology and treatment of a chronic corneal ulcer after endophthalmitis.

Emergencies department and external consults of Hospital General Universitario Gregorio Marañón.

A review of electronic clinical records and iconography, combined with wide literature research.

A 74 year old patient, with a history of diabetes underwent a resection and reconstruction on the upper right eyelid after a diagnosis of melanoma. A mild lagophthalmos ensued. A year after, the patient underwent cataract surgery, with a second surgery a month later due to a piece of nucleus in the anterior chamber. Endophthalmitis is diagnosed and intravitreal injections are given with good response. A month later a corneal ulcer with endothelitis is seen. An amniotic membrane transplant was made and an aqueous humor punction was positive for MRSA. White infiltrates appeared weeks later with a culture positive for candida parapsilosis. Voriconazole was initiated with slow improvement until resolution of the infection.

Culture of corneal scrapes is the preferred initial test to identify the culprit organism. In non-responders, the posibility of a coinfectious should be considered. Although the aqueous humor PCR was negative, the recurrent anterior chamber uveitis and endothelitis may be compatible with herpes virus. In this case, it wasn’t until white infiltrates appeared that the etiologic agent was typified. Risk factors for fungal keratitis include previous intraocular surgery, diabetes mellitus and prolonged corticosteroid use. In this case the combination of factors including mild cicatricial lagophthalmos, diabetes mellitus, previous surgeries and exogenous endophthalmitis coalesced.