Fungal Keratitis and Corneal Perforation as a Rare Complication of Corneal Collagen Cross-Linking Treatment.
Female
Humans
Young Adult
Adult
Keratoconus
/ complications
Corneal Perforation
/ chemically induced
Corneal Cross-Linking
Photosensitizing Agents
/ therapeutic use
Fluconazole
/ therapeutic use
Corneal Ulcer
/ diagnosis
Keratitis
/ microbiology
Riboflavin
/ therapeutic use
Eye Infections, Fungal
/ diagnosis
Cross-Linking Reagents
/ therapeutic use
Ultraviolet Rays
Journal
Cornea
ISSN: 1536-4798
Titre abrégé: Cornea
Pays: United States
ID NLM: 8216186
Informations de publication
Date de publication:
01 Sep 2023
01 Sep 2023
Historique:
received:
30
11
2022
accepted:
31
01
2023
medline:
7
8
2023
pubmed:
8
3
2023
entrez:
7
3
2023
Statut:
ppublish
Résumé
The aim of this study was to report a case of fungal keratitis with subsequent corneal perforation after corneal collagen cross-linking (CXL) treatment performed for keratoconus. A 20-year-old woman presented with redness and discharge in the left eye. She had a history of bilateral CXL procedure performed for keratoconus elsewhere 4 days earlier. The visual acuity was hand motion in the left eye. Slit-lamp examination revealed extended corneal melting with surrounding infiltrates. The patient was hospitalized, and corneal epithelial scraping samples were sent for microbiological assessment. In the meantime, empirical antibiotic therapy (fortified topical antibiotics: vancomycin 50 mg/mL, ceftazidime 50 mg/mL, and fluconazole 2 mg/mL q1 hour) was initiated. In direct microscopy of the corneal scraping, septate hyaline fungal hyphae were detected and topical fluconazole was switched to topical voriconazole (10 mg/mL). Three days after hospitalization, corneal melting progressed to perforation and corneal suturing with 10-0 monofilament was performed to reform the anterior chamber. Complete resolution of keratitis with residual scarring was noticed in 2 weeks. Three months later, penetrating keratoplasty was performed to obtain better visual acuity. CXL with riboflavin has become a common procedure to prevent keratoconus progression by strengthening the biomechanical specialties of the cornea. Although the treatment itself has been used in the management of microbial keratitis and related corneal melting, fungal keratitis and corneal perforation after a CXL procedure for keratoconus might also be detected. Clinicians should be aware of this rare but devastating complication of CXL treatment and start prompt treatment when suspected.
Identifiants
pubmed: 36881003
doi: 10.1097/ICO.0000000000003270
pii: 00003226-990000000-00254
doi:
Substances chimiques
Photosensitizing Agents
0
Fluconazole
8VZV102JFY
Riboflavin
TLM2976OFR
Cross-Linking Reagents
0
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1179-1182Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors have no funding or conflicts of interest to disclose.
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