Management Of Resistant Fusarium Keratitis With Therapeutic Keratoplasty
Published 2024 - 42nd Congress of the ESCRS
Reference: PO191 | Type: Case Report | DOI: 10.82333/4cnw-3c60
Authors: Yasmine Bennani* 1 , boutaina bousellam 1 , Hibat Allah Eddaoui 1 , Youness Bouhafra 1 , soufiane benchrif 2 , sefiani salma 1 , mounir boufeloussen 1 , Rim bennani kamane 1 , Aniss regragui 1 , nabiha benchekroun 1 , Mohamed Belmekki 1
1Ophtalmology center,cheikh zaid hospital,Rabat,Morocco, 2Ophtalmology center,cheikh zaid hospital,rabat,Morocco
Purpose
Fungal aetiology of keratitis is considered to be one of the leading causes of ocular morbidity, particularly in developing countries including Morocco.
Management of resistant Fusarium keratitis with therapeutic keratoplasty is very challenging, especially considering the post operative treatment and the possible recurrence of the desease on the corneal graft.
The purpose of this case report is to highlight the continuum of procedures available to treat resistant keratomycosis.
Setting
Fusarium keratitis is a Corneal infectious disease which represents a major cause of monocular blindness, especially in developing countries. Late diagnosis or inadequate medical treatment may lead to severe corneal thinning, descemetocele, perforation of the cornea, or even endophthalmitis; and may require more or less invasive surgical procedures such as amniotic membrane graft, intrastromal voriconazole injection (IVI), or therapeutic keratoplasty.
Report of case
A 59-year-old male was referred with a history of sudden redness, pain, tearing, photophobia, and decreased vision of the left eye. The patient denied any history of herpes simplex, ocular trauma, and contact lens wear, but reported exposure to a sandstorm two weeks before symptoms.
The best-corrected visual acuity was of 6/10 for the right eye, and light perception for the left eye. The right eye slit-lamp examination was normal. The left eye showed intense diffuse conjunctival hyperemia, a large corneal necrosis and descemetocele.
The anterior chamber was absent and the fundus was unassessable.
Superficial corneal scrapping was made. Empirical fortified antibiotics and antifungal were begun immediately after the specimen has been taken, and consisted of topical vancomycin (5%), ceftazidime (2%), amphotericine B. No Topical or general corticosteroids were allowed. Despite the use of fortified antimicrobial agents, evolution was marked by the worsening of the symptomatology. The culture revealed Fusarium sp..
After 24 hours, evolution was pejorative, and the decision was made to perform a therapeutic keratoplasty (TK).
Postoperatively, the patient remained under oral and fortified treatment.
No sign of infection recurrence was noted initially. Fourteen days after TK, the patient presented a corneal graft abscess with satellite lesions, and deep stromal neovascularization with massive hypopion, which is a sign of reactivation of the fungal infection.
Conclusion/Take home message
The literature describes therapeutic keratoplasty as a management option of infectious keratitis resistant to maximal medical treatment, or with an eminent risk of corneal perforation, or endophthalmitis.
The post-operative period is the most complex to manage as it requires close monitoring with day-to-day adaptation of the treatment.
Whatever the etiology, the main objective of therapeutic keratoplasty is to preserve the integrity of the eye and to eradicate the infectious process, visual rehabilitation is a secondary objective.
Anterior lamellar grafts can be an alternative that could improve the postoperative period of these patients, however the indication for the graft must be made early.