Topic outline

  • Grand Rounds

    A patient with history of herpetic keratitis referred to cornea service with multifocal, white, anterior stromal deposits left eye. Examination revealed 20/20 with inferior and temporal paracentral, multifocal white deposits on the anterior stroma. The deposits were debrided. Cultures revealed rapid growth of multi-drug resistant Mycobacteria. Multi-agent treatment (topical Moxifloxacin, Amikacin and oral Clarithromycin) was started, and topical steroids discontinued. The precipitates resolved over the course of 4 weeks, but the patient experienced a recurrence of herpetic keratitis with decrease in vision to 20/400. Steroids were restarted while continuing topical anti-mycobacterial treatment. The patient regained 20/20 vision by 9 weeks and antibiotics were discontinued. At 11 weeks, corneal precipitates returned, prompting re-initiation of topical Amikacin. The treatment course is documented photographically in this presentation.

    Presentation Date: 12/17/2020
    Issue Date: 07/23/2021