Epidermophyton fungal keratitis following laser-assisted subepithelial keratectomy

A 40-year-old man developed pain, decreased vision, and a corneal infiltrate 10 days after laser-assisted subepithelial keratectomy. Treatment with conventional topical and systemic antibiotic agents did not improve the symptoms. Approximately 2 weeks after surgery, the patient was referred to Kim's Eye Hospital, presenting with counting fingers visual acuity, moderate anterior chamber reaction, and multifocal stromal infiltrates in the left eye. The corneal infiltrate findings were suggestive of fungal keratitis, and corneal smears were positive for septate fungal hyphae. Treatment with topical amphotericin B was initiated, but there was little response. After mycology culture and molecular analysis identified Epidermophyton floccosum as the infectious organism, topical natamycin was added and the infiltrate gradually resolved. Three weeks after treatment with natamycin, the corrected visual acuity was 20/25. Treatment with topical natamycin was effective against Epidermophyton keratitis.