Fusarium keratitis and endophthalmitis associated with lens contact wear.
BACKGROUND
Fusarium keratitis is a severe corneal infection that is usually seen in tropical and subtropical countries after a corneal trauma. In 2005-2006, an epidemic of Fusarium keratitis, occurring predominantly among contact lens wearers, was observed in several countries.


METHODS
We describe the clinical course of a Fusarium keratitis which failed to respond to systemic and local voriconazole treatment, and experienced a progression to a severe keratitis with endophthalmitis, requiring early therapeutic keratoplasty ("à chaud"). After 8 months of follow up, the vision recovered to 20/50.


CONCLUSIONS
After the 2005-2006 worldwide epidemics, case-control studies pointed out that a new lens care solution, ReNu with MoistureLoc (Bausch & Lomb), was likely responsible of numerous cases. Complementary studies underlined that this infection mostly concerned non-compliant patients, i.e., those reusing the solution several times, since this results in a decrease of the antifungal activity due to the uptake of the biguanides into the lens.


CONCLUSIONS
Fusarium endophtalmitis can result in a devastating disease with a poor visual outcome. An initial antifungal dual therapy may control the infection. In case of failure, an early keratoplasty may be mandatory. For contact lens wearers, education on sanitary good practice is necessary to avoid new epidemics in the future.
Department of Ophthalmology, Bicêtre University Hospital, APHP, University Paris XI, Le Kremlin Bicêtre, Paris, France.
Julia
J
Proença-Pina
Isabelle
I
Ssi Yan Kai
Tristan
T
Bourcier
Monique
M
Fabre
Hervé
H
Offret
Marc
M
Labetoulle
D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage; D018639:Contact Lens Solutions / Q000009:adverse effects; D003261:Contact Lenses; D003315:Cornea / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D016039:Corneal Transplantation; D018450:Disease Progression; D025141:Drug Resistance, Fungal; D009877:Endophthalmitis / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D005670:Fusarium / Q000302:isolation & purification*; D006801:Humans; D007634:Keratitis / Q000150:complications / Q000382:microbiology* / Q000473:pathology / Q000628:therapy; D008297:Male; D010349:Patient Compliance; D011743:Pyrimidines / Q000008:administration & dosage; D013997:Time Factors; D014230:Triazoles / Q000008:administration & dosage; D014792:Visual Acuity; D065819:Voriconazole
D000935:Antifungal Agents; D018639:Contact Lens Solutions; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole