A 59-year-old female presented to the Bascom Palmer Eye Institute emergency room with a 7-day history of a red and painful eye, and loss of vision. The right eye exam demonstrated HM vision with a diffuse limbal-to-limbal cornea ulcer within a previous penetrating keratoplasty graft. Corneal scrapings were diagnostic for fungal growth. Treatment with nystatin was started within 3 days of first encounter, and when cultures came back positive for fusarium, she was subsequently treated with oral voriconazole. Despite systemic treatment, she developed a hypopyon and b-scan ultrasound was concerning for possible endophthalmitis. She eventually had a cornea perforation and underwent a therapeutic penetrating keratoplasty. An injection of intra-stromal voriconazole was performed post-operatively and her vision continued to improve and the infiltrate cleared. She developed inferior keratic precipitates two weeks later, and with concern for early graft rejection, was started on topical prednisolone drops. This presents a therapeutic dilemma, as prednisolone drops have been known to cause a recurrence of fungal keratitis. Fungal keratitis remains very difficult to treat and there are currently new research ideas on the horizon, including rose bengal photodynamic therapy.
Presentation Date: 10/11/2018
Issue Date: 08/01/2020