Eyeworld

Figure 3: Slit lamp photo shows patient 4 months following anterior chamber washout with intracameral amphotericin B and voriconazole. There is persisting temporal corneal haze and edema but overall graft clarity. Source (all): John A. Moran Eye Center the differential diagnosis of chronic graft failure. Although the most common cause of fungal keratitis is Candida albicans, other rare fungal pathogens can cause a similar clin- ical picture. Our patient responded well to a combination of topical, intracameral, and systemic antifun- gal therapy. EW References 1. Antonios, SR et al. Contamination of donor cornea: postpenetrating keratoplasty endoph- thalmitis. Cornea 1991;10(3):217–220. 2. Badenoch, PR et al. Ulocladium atrum keratitis. Journal of Clinical Microbiology 2006;44(3): 1190–1193. 3. Price, Marianne O et al. Photoactivated ri- boflavin treatment of infectious keratitis using collagen cross-linking technology. Journal of Refractive Surgery 2012; 28(10):706–713. 4. Keyhani, Kayvan et al. The incidence of fungal keratitis and endophthalmitis following penetrating keratoplasty. Cornea 2005;24(3):288–291. 5. Fisher MC et al. Emerging fungal threats to animal, plant, and ecosystem health. Nature 2012; 484(7393):186–194. 6. Das S et al. Diagnosis, clinical features and treatment outcome of microsporidial kerato- conjunctivitis. British Journal of Ophthalmolo- gy 2012;96(6)793–795. Contact information Jorgensen: adam.jorgensen@hsc.utah.edu Pettey: jeff.pettey@hsc.utah.edu with a history of prolonged epitheli- al defects or chronic steroid use. Outcome Dr. Mifflin took the patient to the OR for anterior chamber washout with intracameral injection of am- photericin B and voriconazole. Two weeks following surgery the patient had count-fingers vision, but with markedly diminished anterior cham- ber cell and fibrin. The patient had a mature cataract and a persistent epithelial defect, for which cataract extraction with IOL insertion was performed and temporary tarsor- rhaphy placed 8 weeks following surgery. She was then maintained on prophylactic oral acyclovir, difluprednate, and frequent artifi- cial tears and ointment. Ulocladium sp. from the first corneal scraping was confirmed by DNA sequencing. All bacterial cultures and PCRs for herpes simplex and zoster viruses remained negative at final report. At 4-month postoperative follow-up, best corrected visual acuity was 20/100 with overall graft clarity (Fig- ure 3). At 7-month follow-up, best corrected visual acuity had improved to 20/60 with central graft clarity and no evidence of rejection. Take-home points Fungal keratitis is a known compli- cation following penetrating kera- toplasty and should be included in

• Cover