Posters

Deep corneal ulcer as a complication of fungal keratitis: surgical solution

Poster Details

First Author: M.Zemba ROMANIA

Co Author(s):    C. Tataru   A. Stamate                 

Abstract Details

Purpose:

To report the case of a patient with a deep corneal ulcer after an untreated fungal keratitis and to describe the clinical outcome after conjunctival flap surgery.

Setting:

Department of Ophthalmology, “Dr. Carol Davila” Central Military Emergency University Hospital, Bucharest, Romania

Methods:

A 66-year-old male presented to our clinic complaining of progressive blurred vision, grittiness and photophobia in the right eye for several weeks. After thorough anamnesis, the patient recalled a minor ocular trauma. Slit lamp examination: minimal conjunctival injection, a central gray-white stromal infiltrate with irregular feathery margins, associated satellite lesions and a deep corneal ulceration at the inferior margin of the infiltrate. Anterior segment OCT: corneal ulceration with a residual stroma of about 100 microns at the thinnest area, an intact overlying epithelium, adjacent stromal infiltration and aggregates of inflammatory cells in the anterior chamber and on the endothelial surface.

Results:

Considering the risk of corneal perforation and availability of treatment options, we decided to perform a temporary conjunctival flap. After one month the conjunctival flap was removed, and visual acuity improved, the area of stromal infiltration and inflammation decreased in density and size, the corneal epithelium was intact, and most importantly the ulceration stabilized and an increase of almost 50 microns in corneal thickness (a total of about 150 microns at the thinnest area) was measured on anterior segment OCT.

Conclusions:

Fungal keratitis represents one of the most difficult forms of microbial keratitis for the ophthalmologist to diagnose and treat successfully. Surgical treatment is almost mandatory in most parts of the world because of the delay in initiating medical treatment or the inability to obtain antifungal medications. Conjunctival flap can be the procedure of choice in fungal keratitis, especially in situations in which access to topical antifungal agents and the availability of donor corneal tissue are limited. In this particular case, conjunctival flap surgery proved efficient in preventing corneal perforation and its subsequent disastrous complications.

Financial Disclosure:

None