A Case Report on Fortified Drop Toxicity in Refractory Stromal Abscess.

Area of Science:

• Ophthalmology
• Microbiology

Background:

• Corneal stromal abscesses are rare, severe keratitis presentations.
• Deep stromal involvement presents significant therapeutic challenges.

Purpose of the Study:

• To report a case of refractory corneal stromal abscess in an elderly diabetic patient.
• To discuss the management of a challenging corneal stromal abscess.

Main Methods:

• Clinical examination revealed corneal haze, midstromal infiltrates, and hypopyon.
• Initial treatment with fortified topical antibiotics failed, leading to epithelial defects.
• Intrastromal injections of vancomycin and amikacin were administered.
• Therapeutic penetrating keratoplasty was performed due to persistent infection.

Main Results:

• Initial cultures and stains were negative for microorganisms.
• Fortified topical antibiotics caused epithelial toxicity without significant improvement.
• Intrastromal injections and penetrating keratoplasty were crucial for managing the recalcitrant infection.

Conclusions:

• Corneal stromal abscesses can be refractory and challenging to manage.
• Targeted intrastromal therapy and keratoplasty may be required for severe cases.
• Prolonged topical antibiotic use can lead to epithelial toxicity.