Alternaria keratitis and hypopyon after clear-cornea phacoemulsification.
We report a case of Alternaria keratitis and hypopyon following clear-corneal cataract surgery. A 66-year-old woman presented with a painful red left eye several months after uneventful self-sealing clear-corneal phacoemulsification that was unresponsive to prolonged treatment with topical/oral quinolones and topical corticosteroids. A full-thickness stromal white dense infiltrate in the area of the intrastromal tunnel incision and a 2.0 mm hypopyon were observed. Culture from corneal scrapings revealed Alternaria species. Treatment included topical and subconjunctival injections of amphotericin-B (5 mg/mL) and 200 mg of oral ketoconazole. Complete resolution of the corneal infiltration and hypopyon was observed after 30 days of treatment, with no recurrence during 6 years of follow-up. To our knowledge, this is the first report of Alternaria species keratitis complicating self-sealing clear-corneal cataract surgery. Topical and subconjunctival injections of amphotericin-B and oral ketoconazole were effective in resolving the corneal abscess and anterior chamber inflammatory reaction.


BACKGROUND
No author has a financial or proprietary interest in any material or method mentioned.
From the Department of Ophthalmology (Espósito, Maccio, Monti, Urrets-Zavalía), University Clinic Reina Fabiola, Catholic University of Córdoba and CIBICI-CONICET (Cervi, Serra), Faculty of Chemical Sciences, National University of Córdoba, Córdoba, Argentina.
Evangelina
E
Espósito
From the Department of Ophthalmology (Espósito, Maccio, Monti, Urrets-Zavalía), University Clinic Reina Fabiola, Catholic University of Córdoba and CIBICI-CONICET (Cervi, Serra), Faculty of Chemical Sciences, National University of Córdoba, Córdoba, Argentina.
J Pablo
JP
Maccio
From the Department of Ophthalmology (Espósito, Maccio, Monti, Urrets-Zavalía), University Clinic Reina Fabiola, Catholic University of Córdoba and CIBICI-CONICET (Cervi, Serra), Faculty of Chemical Sciences, National University of Córdoba, Córdoba, Argentina.
Rodolfo
R
Monti
From the Department of Ophthalmology (Espósito, Maccio, Monti, Urrets-Zavalía), University Clinic Reina Fabiola, Catholic University of Córdoba and CIBICI-CONICET (Cervi, Serra), Faculty of Chemical Sciences, National University of Córdoba, Córdoba, Argentina.
Laura
L
Cervi
From the Department of Ophthalmology (Espósito, Maccio, Monti, Urrets-Zavalía), University Clinic Reina Fabiola, Catholic University of Córdoba and CIBICI-CONICET (Cervi, Serra), Faculty of Chemical Sciences, National University of Córdoba, Córdoba, Argentina.
Horacio M
HM
Serra
From the Department of Ophthalmology (Espósito, Maccio, Monti, Urrets-Zavalía), University Clinic Reina Fabiola, Catholic University of Córdoba and CIBICI-CONICET (Cervi, Serra), Faculty of Chemical Sciences, National University of Córdoba, Córdoba, Argentina. Electronic address: julioaurrets@gmail.com.
Julio A
JA
Urrets-Zavalía
D000038:Abscess / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D000284:Administration, Oral; D000368:Aged; D000528:Alternaria / Q000302:isolation & purification*; D060487:Alternariosis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D003315:Cornea / Q000187:drug effects / Q000601:surgery*; D003320:Corneal Ulcer / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D006801:Humans; D056965:Injections, Intraocular; D007654:Ketoconazole / Q000627:therapeutic use; D019654:Lens Implantation, Intraocular; D018918:Phacoemulsification; D014792:Visual Acuity / Q000502:physiology
D000935:Antifungal Agents; D000666:Amphotericin B; D007654:Ketoconazole