title: Cross-Linking Treatment and Corneal Transplant in Refractory Acremonium Keratitis: Case Report.
abstract: OBJECTIVE
  To report a case of Acremonium keratitis treated with voriconazole, corneal collagen cross-linking, and corneal transplant.
  
  
  METHODS
  Case report.
  
  
  RESULTS
  A 42-year-old woman who wore contact lenses daily was referred for refractory keratitis. Her main complaints were gritty sensation and pain. At slit lamp biomicroscopy, an infiltrate on the inferior paracentral cornea and an arcuate conjunctival ulceration were evident. The rest of the cornea was clear with no anterior chamber reaction. Scrapings from the corneal ulcer showed Candida parapsilosis and Acremonium species, which were sensitive to voriconazole. Despite the administration of topical, systemic, and intrastromal voriconazole for 1 month, repeat corneal scraping was positive for Acremonium, and clinical appearance and pain did not resolve. Therefore, corneal collagen cross-linking was applied. Although the pain resolved immediately after the procedure, the lesion showed no improvement. After a month of cross-linking, corneal transplant was performed for visual rehabilitation and treatment of the refractory lesion. The excised corneal button was negative for any microorganisms.
  
  
  CONCLUSIONS
  Although corneal collagen cross-linking may be an effective treatment for Acremonium keratitis refractory to medical therapy, corneal transplant was required for visual gain and recovery.
authors.affiliation: From the Department of , Ophthalmology, Ege University Faculty of Medicine, Izmir, Turkey.
authors.forename: Ayse
authors.initials: A
authors.lastname: Yagci
authors.forename: Melis
authors.initials: M
authors.lastname: Palamar
authors.forename: Suleyha
authors.initials: S
authors.lastname: Polat Hilmioglu
authors.forename: Murat
authors.initials: M
authors.lastname: Irkec
mesh_terms: D000164:Acremonium / Q000302:isolation & purification*; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D003094:Collagen / Q000378:metabolism*; D016039:Corneal Transplantation; D003432:Cross-Linking Reagents / Q000627:therapeutic use*; D015821:Eye Infections, Fungal / Q000378:metabolism / Q000382:microbiology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D007634:Keratitis / Q000378:metabolism / Q000382:microbiology / Q000503:physiopathology / Q000628:therapy*; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D020127:Recovery of Function; D012256:Riboflavin / Q000627:therapeutic use*; D016896:Treatment Outcome; D014467:Ultraviolet Therapy / Q000379:methods*; D014785:Vision, Ocular; D065819:Voriconazole / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D003094:Collagen; D065819:Voriconazole; D012256:Riboflavin