Penetrating keratoplasty for invasive fungal keratitis resulting from a thorn injury involving Phomopsis species.
OBJECTIVE
The purpose of this study was to report a case of Phomopsis fungal keratitis that was diagnosed 2 months after a rose thorn injury that occurred while gardening.


METHODS
The authors conducted a retrospective case report with literature review.


RESULTS
Deep stromal keratitis with extension of hyphae through Descemet's membrane was treated by therapeutic keratoplasty combined with oral and topical antifungal medications. The causative organism, a Phomopsis species, was identified by culture of the surgical specimens. Phomopsis, a plant fungus, has not been previously reported as a cause of human fungal keratitis. One year after the initial surgery, visual rehabilitation was accomplished with a repeat cornea transplant and cataract extraction with return of vision to 20/25.


CONCLUSIONS
Advanced fungal keratitis can be successfully treated by a combination of surgery to debulk the infectious organisms and pre- and postoperative medical therapy. Prompt recognition of fungal keratitis will increase the likelihood of cure. Phomopsis species, ubiquitous plant fungi, can cause infectious keratitis in humans.
Mandell
Kenneth J
KJ
Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard School of Medicine, Boston, USA.
Colby
Kathryn A
KA
D000284:Administration, Oral; D000666:Amphotericin B / Q000008:administration & dosage; D000935:Antifungal Agents / Q000008:administration & dosage; D001203:Ascomycota; D002386:Cataract / Q000209:etiology; D002387:Cataract Extraction; D003320:Corneal Ulcer / Q000209:etiology; D015821:Eye Infections, Fungal / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D015807:Eye Injuries, Penetrating / Q000150:complications* / Q000209:etiology; D051639:Gardening; D006801:Humans; D007634:Keratitis / Q000382:microbiology* / Q000473:pathology / Q000601:surgery*; D015948:Keratoplasty, Penetrating / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010935:Plant Diseases / Q000382:microbiology*; D011182:Postoperative Care; D011743:Pyrimidines / Q000008:administration & dosage; D012086:Reoperation; D014230:Triazoles / Q000008:administration & dosage; D065819:Voriconazole
D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D000666:Amphotericin B; D065819:Voriconazole