title: Unusual case of Scedosporium apiospermum keratitis following phacoemulsification in a systemically well patient.
abstract: We report the case of a 65-year-old immunocompetent woman who developed Scedosporium apiospermum keratitis after clear-corneal phacoemulsification. A 3.5 mm by 2.7 mm full-thickness stromal infiltrate, corresponding to the superior 2.75 mm clear-corneal incision, was observed 44 days postoperatively. Treatment included preservative-free voriconazole 1.0% hourly, ofloxacin 0.3% 6 times a day, oral voriconazole 200 mg once daily, natamycin 5.0% hourly, dexamethasone 0.1% 4 times a day, and ocular cyclosporine 4 times a day. After 4 months of treatment, the new vessels had regressed, the infiltrate had disappeared, and residual deep scarring remained; the uncorrected distance visual acuity was 0.8 logMAR. To our knowledge, this is the first case of S apiospermum keratitis following clear-corneal phacoemulsification. Another unusual feature is that there were no risk factors for fungal keratitis, specifically no history of trauma, systemic illness, immunosuppression, or contact lens wear.
  
  
  BACKGROUND
  No author has a financial or proprietary interest in any material or method mentioned.
authors.affiliation: From the Ophthalmology Department, Royal Free Hospital, London, United Kingdom. Electronic address: gurj14@hotmail.co.uk.
authors.forename: Gurjeet
authors.initials: G
authors.lastname: Jutley
authors.affiliation: From the Ophthalmology Department, Royal Free Hospital, London, United Kingdom.
authors.forename: Antigoni
authors.initials: A
authors.lastname: Koukkoulli
authors.affiliation: From the Ophthalmology Department, Royal Free Hospital, London, United Kingdom.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Forbes
authors.affiliation: From the Ophthalmology Department, Royal Free Hospital, London, United Kingdom.
authors.forename: Vikas
authors.initials: V
authors.lastname: Sharma
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D003320:Corneal Ulcer / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D004359:Drug Therapy, Combination; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D006801:Humans; D007121:Immunocompetence; D019654:Lens Implantation, Intraocular; D018613:Microscopy, Confocal; D009181:Mycoses / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D018918:Phacoemulsification / Q000009:adverse effects*; D012307:Risk Factors; D021681:Scedosporium / Q000302:isolation & purification*; D014792:Visual Acuity / Q000502:physiology
chemical_list: D000935:Antifungal Agents