How Manage Fungal Sclerokeratitis Associated With Panendophthalmitis ?
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR061 | Type: Case Report | DOI: 10.82333/97r8-nt66
Authors: A/Prof. Thibaud Garcin* 1 , Dr Sofia Essadiq 1 , Dr Simon Begnaud 2 , Dr Brigitte Birebent 3 , Dr Lilia Merabet 4 , Prof. Christophe Baudouin 5 , Prof. Vincent Borderie 6 , Prof. Nacim Bouheraoua 6
1Ophthalmology 5,National Hospital 15-20,PARIS,France, 2Ophthalmology 5 ,National Hospital 15-20,Paris,France, 3EFS Tissue Bank,Creteil,France, 4Laboratory Infectiology,National Hospital 15-20,Paris,France, 5Ophtalmology 3,National Hospital 15-20,Paris,France, 6Ophthalmology 5,National Hospital 15-20,Paris,France
Purpose
Setting
CHNV15-20, Infectiology and Transplantation department, GRC32, TITC, Sorbonne University, Paris.
Report of case
Two patients presented with fungal sclerokeratitis associated with panendophthalmitis in a French tertiary center one week apart: a 55-year-old woman with Paecilomyces lilacinus infection since 9-months managed in another center; and a 74-year-old man with Microsporidies (parasite/ex-fungal agent) infection since 12-weeks living in the French West Indies. Both had light perception.The woman’s background was bilateral keratoconus grafted with PK; last year including 5 PK in the infected right eye and IOL removal during last PK.The man’s background was moderated controlled diabetes, bilateral ectropion, bilateral DMEK on bullous keratopathy, then PK on the left eye due to Microsporidies keratitis.
Rather than primary evisceration to treat endophthalmitis with progressive purulent scleral-corneal melting, we proposed a rescue temporary 8mm keratoprosthesis, complete vitrectomy (multiples samples), sclerocorneal transplantation (15mm-diameter), limbal reconstruction and human amniotic graft. The woman had C2F6 tamponade because of macular hole (1200 microns) induced by retinal infectious foci, which was peeled; the man had heavy silicone tamponade because of diabetes, severe endophthalmitis, specific germ and macular infectious foci without hole. We received both corneas from the same 100-year-old donor, with baseline ECD 1800cell/mm2 for rescue purpose. We used both intravitreal and intracameral antibiotics and antifungal agents during the all-in-one surgery.
Conclusion/Take home message
Initial corneoscleral transplantation may be an interesting rescue option by removing most of the infectious load, controlling fungal infection, preventing from early phthisis or evisceration. Repeated intracameral injection were necessary to control the infection. No serious adverse event occurred. Anatomy was restored without primary graft failure, function was partially restored (20/80 for the woman at M4, 20/2000 for the man at M3), without active pain. Donor's age does not matter: a same super old donor can really save 2 younger recipients.