Aspergillus-induced malignant glaucoma.
OBJECTIVE
To report a case of Aspergillus flavus-induced keratomycotic malignant glaucoma.


METHODS
A 48-year-old woman presented with a severe corneal ulcer. She had received topical steroids for 10 days before presentation.


RESULTS
Microbiological studies revealed A. flavus as the offending pathogen. Nonresponsive high intraocular pressure with associated shallow anterior chamber was present. With a diagnosis of keratomycotic malignant glaucoma, the patient underwent therapeutic keratoplasty with cataract extraction with posterior chamber wash. However, there was a recurrence of malignant glaucoma in the postoperative period. Patient underwent limited pars plana vitrectomy.


CONCLUSIONS
Keratomycotic malignant glaucoma is a rare complication of severe fungal ulcer. We believe that the use of topical steroids in this case probably led to increased fungal penetration, with the formation of a lens-iris fungal mass and subsequent malignant glaucoma. Nonresponse to medical therapy warrants urgent surgical intervention. To the best of our knowledge, Aspergillus-induced keratomycotic glaucoma has never been reported previously. This report also highlights that therapeutic keratoplasty with cataract extraction alone may not be sufficient for management of such cases, and a limited pars plana vitrectomy may be needed.
Jain
Vandana
V
Department of Cornea and External Diseases, Aditya Jyot Eye Hospital Pvt Ltd, Wadala, Mumbai, India. docvandanajain@rediffmail.com
Maiti
Aniruddha
A
Shome
Debraj
D
Borse
Nishikant
N
Natarajan
Sundaram
S
D000959:Antihypertensive Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000150:complications* / Q000382:microbiology / Q000601:surgery; D001231:Aspergillus flavus / Q000302:isolation & purification*; D003320:Corneal Ulcer / Q000150:complications* / Q000382:microbiology / Q000601:surgery; D015821:Eye Infections, Fungal / Q000150:complications* / Q000382:microbiology / Q000601:surgery; D005260:Female; D005901:Glaucoma / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D015948:Keratoplasty, Penetrating; D008875:Middle Aged; D013999:Timolol / Q000627:therapeutic use
D000959:Antihypertensive Agents; D013999:Timolol