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Fungal keratitis after amniotic membrane placement
Lena Chen1, Deena Dahshan1, Thomas Mauger1
1West Virginia University Department of Ophthalmology, Morgantown, WV, USA.
Purpose:
We present two cases of fungal keratitis following amniotic membrane transplantation, including Sistotrema biggsiae and Fusarium keratitis.
Observations:
A 76-year-old female with a history of anterior basement membrane dystrophy referred for reduced vision and left eye pain ten days following AMT at an outside facility. Despite topical management, the patient continued to worsen clinically, with a recalcitrant course of Fusarium keratitis requiring conjunctival flap, cryotherapy, and intracameral and intrastromal injection. The second case involved a 46-year-old male with a history of recurrent corneal erosions referred for blurry vision and pain in his left eye seven days following AMT. He was found to have Sistotrema biggsiae keratitis and had remarkable visual improvement with topical management.
Conclusions:
Fungal keratitis following amniotic membrane placement has not been reported presenting within ten days after transplantation. This is the first report of Sistotrema biggsiae infection in humans. This case series highlights the risk of severe recalcitrant microbial keratitis presenting within days after AMT placement and recognizing fungal etiologies not previously reported in literature. The risk of keratitis following AMT should be considered with close patient follow up, especially in patients with monocular vision.
Insights
Fungal keratitis, including rare Sistotrema biggsiae, can occur days after amniotic membrane transplantation (AMT). Early recognition and management are crucial for preventing severe vision loss in patients undergoing AMT.
Area of Science:
- Ophthalmology
- Microbiology
- Transplantation
Background:
- Amniotic membrane transplantation (AMT) is a common procedure for corneal healing.
- Fungal keratitis is a rare but serious complication following AMT.
Observation:
- Two cases of fungal keratitis post-AMT are presented: Fusarium and Sistotrema biggsiae.
- One patient required extensive treatment for Fusarium keratitis, while the other improved with topical therapy for S. biggsiae.
Findings:
- This is the first reported case of Sistotrema biggsiae keratitis in humans.
- Fungal keratitis can present within 10 days of AMT, a previously unreported timeframe.
Implications:
- Highlights the risk of severe microbial keratitis after AMT, emphasizing prompt diagnosis.
- Underscores the importance of considering unusual fungal pathogens and close patient monitoring post-AMT, especially in monocular patients.
