Therapeutic Keratoplasty for Fusarium Keratitis

Abstract

Purpose: This study evaluates the effectiveness of therapeutic keratoplasty for Fusarium fungal keratitis and explores the diagnosis and management challenges of this infectious corneal disease. Methods: We retrospectively analyzed therapeutic keratoplasty cases at a tertiary hospital for Fusarium keratitis when standard treatments failed. Results: Five cases of Fusarium keratitis, unresponsive to typical antifungal treatments, required keratoplasty due to fast progression and diagnostic difficulties. Post-surgery, all patients had infection resolution without recurrence, but some complications like anterior chamber leakage, graft rejection, and ocular hypertension were managed effectively. Final visual acuity ranged from 0.9 to finger counting. Conclusions: Fusarium keratitis, often resistant to conventional therapies, may necessitate keratoplasty for resolution. This intervention is crucial for positive outcomes, emphasizing the need for prompt and effective management to prevent severe surgical measures and preserve ocular health.

Keywords: Fusarium; corneal transplantation; fungal keratitis; ocular mycosis; therapeutic keratoplasty.

Figure 1

(A–C) First case. Clinical progression of corneal abscess caused by Fusarium sp. in a 51-year-old female: (A) initial presentation at our hospital after three months of corneal abscess, undergoing treatment with topical and systemic voriconazole; (B) evolution despite antifungal therapy; (C) status 24 h post-therapeutic TPK, demonstrating the absence of infectious manifestations with resolved anterior chamber activity. (D–F) Second case. Clinical progression of corneal abscess caused by Fusarium Solani in a 61-year-old female: (D) first visit at our hospital with one-month evolution corneal abscess and visual acuity of light perception; (E) status 24 h post-TPK, minor superior infiltration at the host interface; (F) four months post-transplantation, persistent central corneal epithelial defect, and stromal thickening but no active infection. (G–I) Third case. Clinical progression of corneal abscess caused by Fusarium spp. in a 56-year-old female: (G) rapidly evolving corneal ulcer exhibiting full-thickness corneal involvement and anterior chamber reaction; (H) status 24 h after a large-diameter TPK, with no residual infection; (I) status one month after the second large-diameter PK and Ahmed glaucoma valve implantation. Due to an internal server error, further images of the third case were lost and could not be retrieved.

Figure 2

Clinical progression of corneal fungal abscess in a 60-year-old female: (A) initial diagnosis showing a central corneal abscess without anterior chamber inflammation; (B,C) important aggravation of the infection, with progressive hypopyon and iridian synechiae; (D) status 48 h post-TPK, demonstrating initial postoperative condition with lack of epithelialization of the graft; (E) twenty days post-transplantation, showing no recurrence of infection; (F) two years post-transplantation, after viscosynechialysis and cataract extraction with intraocular lens implantation surgery.

Figure 3

Clinical progression of corneal perforation in a 33-year-old female due to fungal abscess: (A,B) initial diagnosis showing a full-thickness corneal abscess with evident corneal perforation; (C) status 24 h post-therapeutic TPK, indicating initial postoperative condition; (D) twenty days post-transplantation, showing a residual temporal infectious abscess; (E) two months post-transplantation, with no residual infection and gradual reduction of vancomycin treatment; (F) three years post-keratoplasty, demonstrating sustained corneal transparency; (G,H) in vivo confocal microscopy (IVCM) at presentation. The procedure was performed with a Heidelberg Retina Tomograph with Rostock Cornea Module; (G) fungal hyphae at the epithelial depth (0 µm) varying in length, reflectivity, and width highly suggestive of Fusarium spp.; (H) fungal hyphae extending deeper into the stroma to 245 µm and 289 µm.