Case Reports Of Two Contrasting Presentations Of Paecilomyces Fungal Keratitis
Published 2024 - 42nd Congress of the ESCRS
Reference: PO730 | Type: Poster | DOI: 10.82333/t3ds-yw96
Authors: Priyadarshini Kamalakannan* 1 , Namrata Sharma 2
1Ophthalmology,ALL INDIA INSTITUTE OF MEDICAL SCIENCES,New Delhi,India;Ophthalmology,ASG Eye Hospital,Jodhpur,India;Ophthalmology,All India Institue of Medical Sciences,New Delhi,India;Ophthalmology,ASG Eye Hospital,jodhpur,India, 2Ophthalmology,All India Institue of Medical Sciences,New Delhi,India
Purpose
To report two contrasting presentations of the rare Paecilomyces fungal keratitis and their management strategies
Setting
Tertiary Eye Care Hospital, India
Methods
Case 1: A 65-year-old female who presented with recalcitrant keratitis after Small-incision cataract surgery, with Paecilomyces growth on fungal culture, was initially treated with topical (Voriconazole 1%) and oral antifungal (Tab Voriconazole 200 mg BD), later had to be given multiple intrastromal and intracameral injections of voriconazole (6 times every 3 days).
Case 2: A 45-year-old male who presented with keratitis post-trauma, with Paecilomyces growth on fungal culture was treated with topical and oral antifungal drugs.
Results
Repeated Intrastromal voriconazole injections were useful in the resolution of recalcitrant Paecilomyces keratitis in the 65-year-old female patient, whereas early presentation in the 45-year-old male could be managed with topical and oral antifungals. The keratitis resolved after 6 doses of intracameral and intrastromal antifungal (targeted therapy) in addition to topical and systemic antifungal agents after 3 months of onset of therapy in our first case, while our second case showed resolution with topical and oral antifungal agents in 3 weeks after starting therapy.
Conclusions
Non-resolving Paecilomyces fungal keratitis can be treated with repeated injections of intrastromal voriconazole before contemplating therapeutic keratoplasty. Targeted intrastromal therapy plays an important role in recalcitrant cases of Paecilomyces fungal keratitis.