Posters

Acute corneal hydrops in fungal keratitis in a 10 year-old boy: case report and review on paediatric keratitis

Poster Details

First Author: S. Barros PORTUGAL

Co Author(s):    A. Santos   L. Barbosa de Sousa                 

Abstract Details

Purpose:

Infectious keratitis (IK) is a leading cause of monocular blindness worldwide. Case series studies have demonstrated that the disease is more troublesome in the pediatric setting, in which clinical examination, workup and management are more challenging. Besides these concerns, major concern is present due to corneal sequelae that may lead to amblyopia and a significant burden throughout childrens life. We present an extreme case of a child diagnosed with fungal ulcer complicated with acute hydrops managed with penetrating keratoplasty (PK) and a review of IK in the pediatric population published in the literature with particular emphasis in fungal keratitis.

Setting:

Department of Ophthalmology and Visual Sciences of Federal University of São Paulo – UNIFESP, São Paulo’s Hospital – HSP. Brazil.

Methods:

Epidemiological and clinical data of the patient were collected from his mother and clinical files from the referral hospital. Subsequent data were obtained during examination on our department which included ophthalmological complete examination, microbiological evaluation of ulcer scraping and later, recipient corneal button. The mother of the patient accepted that the case was reported and published. PubMed electronic database was searched for a combination of terms including infectious, keratitis, fungal, children, pediatric.

Results:

10 year-old boy, healthy, no ocular trauma, diagnosed 14 days before in a peripheral hospital with left eye infectious keratitis, refractory to treatment with oral acyclovir, topical moxifloxacin, natamycin and amphotericin B, biguanide and chlorhexidine in chronological order. No definite diagnosis was achieved despite ulcer sample culture. Visual acuity was light perception when he first attended HSP. Biomicroscopy: white, large, central corneal infiltrate, feathery borders, hipopion, hydrops. PK was performed. Corneal button was positive for Fusarium Oxysporum and anatomopathological study corroborated descemetocele. 20 days after, VA was 20/100. Less than 10 articles concerning epidemiology of IK in children were published.

Conclusions:

This case represents a potentially blinding complication of IK due to Fusarium sp. in a child, successfully managed. Most epidemiological studies on IK show that bacteria are the commonest agents, male gender predilection and trauma the most common predisposing factor. Despite these facts, socioeconomic background and geographic features play an important role: one study reported fungi as the most common agent in South India, females may be affected more in Southeast Asia and contact-lens was the most common risk factor in Taiwan and Hong-Kong. Knowledge on these aspects may facilitate prevention and prompt management, improving outcomes in these patients.

Financial Disclosure:

NONE