Where There Is Will, There Is Hope: Penetrating Keratoplasty And Extracapsular Cataract Extraction In A Patient With Fusarium Keratitis
Published 2024 - 42nd Congress of the ESCRS
Reference: PP16.04 | Type: Free paper | DOI: 10.82333/pee6-f359
Authors: Ana Gama-Castro* 1 , Rita Rodrigues 1 , Pedro Mota-Moreira 1 , Pedro Neves-Cardoso 1 , João Pinheiro-Costa 2 , Luís Torrão 1 , Raul Moreira 1 , Ana Maria Cunha 1
1Ophtalmology,ULS São João,Porto,Portugal, 2Ophtalmology,ULS São João,Porto,Portugal;Anatomy Department,Faculdade de Medicina da Universidade do Porto,Porto,Portugal
Purpose
To present a complex case of Fusarium keratitis treated with penetrating keratoplasty (PK) and extracapsular cataract extraction (ECCE). The challenges of managing fungal keratitis are highlighted, emphasizing the importance of a multifaceted therapeutic approach.
Setting
Case report of a patient with Fusarium keratitis referred to the Ophthalmology Department of ULS São João, Porto, Portugal, in August 2023 for performing a PK for Fusarium keratitis.
Methods
The patient was initially submitted to PK. Due to persistent infection in the anterior chamber (AC), the patient underwent six AC washouts with administration of voriconazole and amphotericin intracameral and intrastromal, along with systemic and topical antifungal treatment. Despite these efforts, corneal decompensation and persistent ocular fungal endophthalmitis led to a subsequent procedure, which involved PK with extracapsular cataract extraction (ECCE) in the left eye.
Results
The donor graft was prepared using a trephine of 9mm. The previous graft was removed, followed by AC washout and removal of a fibrin membrane and fungal remnants anterior to the iris. Anterior capsulorhexis with scissors was followed by hydrodissection and ECCE with a Lewis lens loop in open air. The patient remained aphakic. Finally, the donor graft was sutured with four cardinal sutures and additional twelve sutures with Nylon 10/0, with intracameral and intrastromal voriconazole and amphotericin injection. One month post-procedure, signs of active infection, including hypopyon, were observed. Despite efforts to save the eye, evisceration ensued due to persistent pain, ongoing infection, and the pursuit of an improved quality of life.
Conclusions
Fungal keratitis is highly aggressive with a challenging prognosis. Managing these conditions effectively often necessitates the use of various therapeutic strategies, including topical, oral, and surgical treatments. A multifaceted approach is essential to address the complexity of these infections.