First Author: M.Gessa SPAIN
Co Author(s): I. Relimpio M. D
Purpose:
Describe a clinical case of a patient with severe fungal keratitis by Aspergyllus and its medical and surgycal treatment.
Setting:
Clinical case
Methods:
Men, 60 years old, who complaints for pain and redness of two days duration.
Personal history uninteresting. Rural environment.
Soft contact lens carrier. Old herpetic corneal injury. Chronic use of topical corticosteroids.
BCVA: Light is seen.
Biomicroscopy: Central corneal ulcer with infiltrated stroma. Hypopyon
(1 mm) and mild vitritis. Diagnosed of endophthalmitis, is treated with oral and topical broad-spectrum antibiotics. Improvement in 24 hours, so is reevaluated: complicated disciform keratitis. Microbiology: aspergillus. We decide to do a emergency penetrating keratoplasty with frozen cornea. Topical drops od natamycin, cyclosporin 0.5%, amphotericin 0.15% and cyprofloxacin.
There is a primary graft failure and stromal interface departed
donor-recipient of V and VII and half to half, and ciprofloxacin epithelial deposits.
We do keratectomy: Biopsy of the interface and amniotic membrane.
Biopsy is negative of germens.
Then, we do penetrating keratoplasty (24 stitches)
It is seen Descemet's membrane of stony consistency and
grayish color, separate the corneal stroma.
Posterior treatmnet with prophylactic oral valacyclovir and topical drops of tobramycin, cyprofloxacin and dexamethasone.
6 months later,we realize cataract surgery.
Results:
BCVA: 0.4
No complications
Conclusions:
At a fungal keratitis, faced with failure of medical treatment, surgery should be considered early for mechanical removal of the germ.
Keratoplasty should be performed with trepanation area as wide as possible (including clear zone of cornea without clinical involvement, to avoid leaving residual fungi) and sutures (24-30)
In our case, surprisingly the consistency of the membrane
Descemet frozen graft, which we kept protected
the anterior chamber FINANCIAL DISCLOSURE?: No
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