Curvularia Lunata Keratitis Arising Atop Cyanoacrylate Adhesive In A Patient With Sjogren-Related Corneal Melt: Successful Stabilisation And Subsequent Surface And Cataract Rehabilitation
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR531 | Type: Poster | DOI: 10.82333/2pk8-8k74
Authors: Dr Raksheeth Nathan Rajagopal* 1 , Dr Shreyas Ramamurthy 2
1Cornea, Cataract & Refractive Services,The Eye Foundation,Coimbatore ,India, 2Cornea, Cataract & Refractive Services,The Eye Foundation ,Coimbatore,India
Purpose
To report the clinical course and management of dematiaceous fungal keratitis arising at a cyanoacrylate tissue adhesive (TA) site in a patient with rheumatoid arthritis-related sterile corneal melt and autoimmune dry eye, and to highlight perioperative strategies for subsequent cataract surgery.
Setting
The Eye Foundation, Coimbatore, a tertiary eye care centre in southern India
Methods
A 59-year-old woman with severe aqueous-deficient dry eye and sterile rheumatoid corneal melt in the left eye underwent TA and bandage contact lens (BCL) placement and was commenced on topical loteprednol, moxifloxacin, and lubricants. On development of a pigmented plaque at and around the TA site, the TA/BCL were removed, and corneal scrapings were obtained for microbiological evaluation.
Results
Culture grew Curvularia lunata, confirmed by MALDI-TOF mass spectrometry. Loteprednol was discontinued, and intensive topical natamycin 5% monotherapy was initiated, resulting in complete resolution by 1 month. Ocular surface stability was subsequently achieved with topical cyclosporine and escalation of systemic immunomodulation. Seven months later, staged phacoemulsification with IOL implantation and simultaneous punctal cautery were performed in both eyes. At 2 months postoperatively, the ocular surface remained stable, and the visual outcome was satisfactory. Preoperative Schirmer value of 4mm improved to 19mm in both eyes at the last follow-up visit.
Conclusions
Microbial keratitis can rarely complicate cyanoacrylate adhesive use, particularly on a compromised ocular surface. Early recognition, scraping/microbiological analysis, and prompt initiation of topical antifungal therapy are critical. Ocular surface optimization by topical and systemic immunomodulation, as well as adjunctive punctal cautery, can enable safe and successful cataract rehabilitation in autoimmune dry eye.