Related Experiment Video
Updated: Jan 6, 2026
Iris Fixation via External Pentagram Suturing
Published on: May 5, 2022
[Fungal keratitis after penetrating keratoplasty]
S N Svetozarskiy1, A N Andreev1, S V Shcherbakova1
1Volga District Medical Centre, Federal Medical and Biological Agency, 2 Nizhnevolzhskaya embankment, Nizhny Novgorod, Russian Federation, 603001.
Abstract:
The article presents a case of fungal keratitis after penetrating keratoplasty (PKP). A 35-years old patient had previously undergone surgical removal of an intraocular foreign body and developed chronic keratouveitis and epithelial-endothelial corneal dystrophy. PKP and early postoperative period were uneventful. The patient was frequently monitored with anterior segment photos. Two weeks later, fungal keratitis occurred on the edge of the donor flap. Direct microscopic evaluation revealed fungus spores and filaments, but growth of fungi in culture was negative. Instillation of steroids and antibiotics was discontinued, specific therapy included fluconazole and amphotericin B. Despite the ongoing treatment, keratitis has repeatedly recurred, and infiltrates were scraped. Topical and systemic voriconazole was administered instead of fluconazole in combination with regular scarification. After 3 weeks of treatment with voriconazole, stable corneal epithelialization was achieved and the cornea has restored its transparency. During 1.5 years of the follow-up, keratitis did not reccur; sutures were removed, corrected visual acuity increased to 1.0. Patients who had undergone PKP are at risk of developing fungal keratitis. Frequent monitoring of such patients contributes to early diagnosis of infectious complications. In the absence of officinal antifungal eye drops, specialist has to supply the patient with ex tempore antimycotic agents and change the treatment according to its effectiveness in each specific case.
Insights
Fungal keratitis can occur after penetrating keratoplasty (PKP). Early diagnosis and tailored antifungal treatment, like voriconazole, are crucial for successful outcomes and preventing recurrence in high-risk patients.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Microbiology
Background:
- Penetrating keratoplasty (PKP) is a common procedure for corneal blindness.
- Patients undergoing PKP are at risk for post-operative complications, including infectious keratitis.
- Fungal keratitis presents a significant challenge due to diagnostic difficulties and treatment resistance.
Purpose of the Study:
- To report a case of fungal keratitis following penetrating keratoplasty.
- To highlight the diagnostic challenges and therapeutic strategies for managing post-keratoplasty fungal keratitis.
- To emphasize the importance of vigilant monitoring and individualized treatment in preventing recurrence.
Main Methods:
- Case report of a 35-year-old patient who developed fungal keratitis post-PKP.
- Diagnostic methods included anterior segment photography and direct microscopic evaluation of corneal scrapings.
- Treatment involved discontinuation of steroids/antibiotics, initial antifungal therapy (fluconazole, amphotericin B), and subsequent switch to topical/systemic voriconazole with scarification.
Main Results:
- Fungal keratitis developed at the edge of the donor flap two weeks post-PKP.
- Microscopic evaluation confirmed fungal elements, but cultures were negative.
- Recurrent keratitis despite initial treatment led to a change in antifungal therapy to voriconazole.
- Three weeks of voriconazole treatment resulted in stable epithelialization and corneal transparency.
- No recurrence was observed during 1.5 years of follow-up, with visual acuity improving to 1.0.
Conclusions:
- Fungal keratitis is a potential complication after penetrating keratoplasty.
- Early detection through frequent monitoring is vital for managing infectious complications.
- Effective management requires prompt discontinuation of immunosuppressants and aggressive, individualized antifungal therapy, especially when standard treatments fail or officinal preparations are unavailable.
