title: Intracorneal injection of amphothericin B for recurrent fungal keratitis and endophthalmitis.
abstract: Penetrating keratoplasty carries an infectious risk. Its requirement for topical corticosteroid therapy facilitates fungal growth with resulting keratitis. Although progression of fungal keratitis to intraocular infection is uncommon, endophthalmitis resulting from keratitis usually has a poor visual prognosis. Fungal infection under these circumstances remains a diagnostic and therapeutic challenge. We report a complicated case of recurrent fungal keratitis with endophthalmitis following a contaminated penetrating keratoplasty that ultimately was controlled with a new treatment modality. Intrastromal corneal injections combined with intravitreal injection of amphotericin B led to the eradication of the corneal fungal plaques and the intraocular infection. Intrastromal corneal injections of amphotericin B may offer a less invasive, in-office alternative to repeat penetrating keratoplasty.
authors.affiliation: Emory University Eye Center, Emory University School of Medicine, and Eye Clinic, Atlanta Veterans Affairs Medical Center, Atlanta, Ga, USA. garciaval_retina@yahoo.com
authors.forename: Enrique
authors.initials: E
authors.lastname: Garcia-Valenzuela
authors.forename: C Diane
authors.initials: CD
authors.lastname: Song
mesh_terms: D000369:Aged, 80 and over; D000666:Amphotericin B / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use; D041221:Candida glabrata / Q000302:isolation & purification*; D002177:Candidiasis / Q000188:drug therapy* / Q000382:microbiology / Q000635:transmission; D003319:Corneal Stroma / Q000187:drug effects* / Q000382:microbiology; D003320:Corneal Ulcer / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D018562:Disease Transmission, Infectious; D009877:Endophthalmitis / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D015821:Eye Infections, Fungal / Q000188:drug therapy* / Q000382:microbiology / Q000635:transmission; D005260:Female; D006801:Humans; D007267:Injections; D015948:Keratoplasty, Penetrating; D012008:Recurrence; D014019:Tissue Donors; D014822:Vitreous Body / Q000382:microbiology
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B