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Non-traumatic mycotic keratitis
L W Hirst1, A Sebban, R M Whitby
1Department of Surgery, University of Queensland, Princess Alexandra Hospital, Woolloongabba, Australia.
Abstract:
Two patients presented with culture proven Paecilomyces corneal infection, and a further patient with histologic evidence of fungal infection, on deep corneal biopsy. In all three cases the corneal infection was macroscopically present only in the depth of the cornea and on the endothelial surface with an intact epithelium and no overlying stromal involvement. Repeated surgery with large corneo-scleral grafts in two cases, and with medical therapy and a small patch-graft alone in the third case, resulted in long-term eradication of the infection and preservation of the globes. Antecedent modulation with steroid and/or cyclophosphamide may well have delayed the diagnosis, however, as there was no history of trauma in any of these cases, we postulate that these infections were not exogenously derived.
Insights
Paecilomyces corneal infections, often deep and involving the endothelium, were successfully treated in three patients. Surgical intervention and medical therapy led to long-term eradication, preserving the eyes.
Area of Science:
- Ophthalmology
- Mycology
- Infectious Diseases
Background:
- Fungal keratitis can present with varied clinical manifestations.
- Paecilomyces species are known opportunistic pathogens.
Observation:
- Three patients presented with deep corneal infections, primarily affecting the endothelium with intact epithelium.
- Two cases confirmed by culture, one by histology, all caused by Paecilomyces.
Findings:
- Surgical interventions, including corneo-scleral grafts and patch-grafts, combined with medical therapy, achieved long-term infection eradication.
- The globes were successfully preserved in all three cases.
Implications:
- Early and accurate diagnosis of deep fungal keratitis is crucial for effective treatment.
- Non-traumatic, endogenous Paecilomyces infections should be considered, especially in immunocompromised patients.
- Aggressive surgical and medical management can lead to favorable outcomes in severe fungal keratitis.