Two Cases of Curvularia geniculata Keratitis Successfully Treated with Natamycin-Based Therapy

This report describes two cases of Curvularia geniculata keratitis, a rare form of fungal keratitis successfully managed with natamycin-based therapy. Both patients presented with characteristic feathery corneal infiltrates following ocular trauma. In vivo confocal microscopy and direct microscopy revealed septate filamentous fungi, and the isolates were definitively identified as C. geniculata through sequence analysis of the translation elongation factor 1-alpha (tef1-α) gene. Antifungal susceptibility testing showed sensitivity to natamycin at 2 μg/mL for both isolates, with variable sensitivity to other antifungal agents. Patient 1 was treated with a combination of topical natamycin and voriconazole, while Patient 2 received natamycin monotherapy. Both patients achieved complete healing and excellent visual outcomes. These cases underscore the importance of accurate molecular identification for species differentiation within the Curvularia genus and demonstrate the efficacy of natamycin-based therapy for C. geniculata keratitis. The choice between monotherapy and combination therapy may be guided by clinical severity and antifungal susceptibility testing. This report contributes to the understanding of the clinical features, diagnosis, and management of this rare condition and highlights the potential value of susceptibility testing in guiding treatment decisions.