title: Successful treatment of Fusarium keratitis after photo refractive keratectomy.
abstract: A 39-year-old woman presented to our hospital with a history of photorefractive keratectomy (PRK), performed two weeks prior; slit-lamp examination revealed diffuse conjunctival congestion, corneal ulcer and stromal infiltration. After 5 days of antifungal and antibacteric treatment, the infiltrate progressively increased so that a therapeutic penetrating keratoplasty was necessary. The microbiological analyses revealed the presence of fungal filaments. Twenty days after surgery the patient had recurrent fungal infiltrate in the donor cornea with wound dehiscence. We performed a second penetrating keratoplasty. With the matrix-assisted-laser-desorption-ionization-time-of-flight analysis (MALDI-TOF) we identified a Fusarium solani. Intravenous amphothericine B, a combination of intracameral and intrastromal voriconazole and intracameral amphotericine B were administered. After 6 months from the last surgery the infection was eradicated. The management of fungal keratitis after PRK depends on many factors: In our experience, a prompt keratoplasty and the use of intracameral antifungal medication proved to be very effective.
authors.affiliation: Institute of Ophthalmology, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Gian Maria
authors.initials: GM
authors.lastname: Cavallini
authors.forename: Pietro
authors.initials: P
authors.lastname: Ducange
authors.forename: Veronica
authors.initials: V
authors.lastname: Volante
authors.forename: Caterina
authors.initials: C
authors.lastname: Benatti
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage; D003315:Cornea / Q000382:microbiology* / Q000473:pathology; D003937:Diagnosis, Differential; D015821:Eye Infections, Fungal / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D060585:Fusariosis / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D005670:Fusarium / Q000302:isolation & purification*; D006801:Humans; D007634:Keratitis / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D009216:Myopia / Q000601:surgery; D009883:Ophthalmic Solutions; D018903:Photorefractive Keratectomy / Q000009:adverse effects*; D011743:Pyrimidines / Q000008:administration & dosage*; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D014230:Triazoles / Q000008:administration & dosage*; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D009883:Ophthalmic Solutions; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole