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Voriconazole-refractory fungal infection of phacoemulsification tunnel.

Mittal V, Mittal R, Sharma PC - Indian J Ophthalmol (2010 Sep-Oct)

Bottom Line: Full-thickness patch graft was done to arrest progressive necrosis.There was no recurrence in one-year follow-up.Present case illustrates the therapeutic challenge in fungal tunnel infections and possibility of voriconazole-resistant Aspergillus species.

View Article: PubMed Central - PubMed

Affiliation: Sanjivni Eye Care, Model Town, Ambala, Haryana, India.

ABSTRACT
A 44-year-old man presented 28 days after cataract surgery (phacoemulsification) in right eye with multiple pinpoint infiltrates in posterior stroma at cataract surgery wound site. Visual acuity was 20/60. Corneal scraping from the floor of the corneal tunnel revealed fungus which was later identified to be Aspergillus flavus. The patient was started on oral voriconazole 200 mg twice daily and topical voriconazole 1% every hour. Two intracameral injections of voriconazole (50 micrograms/ 0.1 ml) were given 72 h apart, five days after starting initial therapy. Infiltrates increased in size and density in spite of 20 days of voriconazole therapy. Full-thickness patch graft was done to arrest progressive necrosis. Four months after surgery, patient had 20/60 best-corrected visual acuity. There was no recurrence in one-year follow-up. Present case illustrates the therapeutic challenge in fungal tunnel infections and possibility of voriconazole-resistant Aspergillus species.

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After 20 days of voriconazole therapy. Infiltrate: 3.1 mm X 4.5 mm; full stromal thickness
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Figure 0003: After 20 days of voriconazole therapy. Infiltrate: 3.1 mm X 4.5 mm; full stromal thickness

Mentions: Infiltrates increased in density, size (2.6 mm × 4 mm) and depth (mid to posterior stroma) within five days of the above treatment [Fig. 2]. To ensure the full therapeutic dose at the site of inoculation of fungus (posterior stroma), two intracameral voriconazole (50 micrograms/ 0.1 ml) injections were given on Day 8 and Day 11 of presentation. Infiltrates increased to 2.8 mm X 4.1 mm and hypopyon appeared on Day 14. Topical natamycin 5% and amphotericin B 0.15% every one hour were added after epithelial debridement. Systemic voriconazole was continued for 20 days. Infiltrates kept on increasing with onset of tissue necrosis [Fig. 3].


Voriconazole-refractory fungal infection of phacoemulsification tunnel.

Mittal V, Mittal R, Sharma PC - Indian J Ophthalmol (2010 Sep-Oct)

After 20 days of voriconazole therapy. Infiltrate: 3.1 mm X 4.5 mm; full stromal thickness
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2992924&req=5

Figure 0003: After 20 days of voriconazole therapy. Infiltrate: 3.1 mm X 4.5 mm; full stromal thickness
Mentions: Infiltrates increased in density, size (2.6 mm × 4 mm) and depth (mid to posterior stroma) within five days of the above treatment [Fig. 2]. To ensure the full therapeutic dose at the site of inoculation of fungus (posterior stroma), two intracameral voriconazole (50 micrograms/ 0.1 ml) injections were given on Day 8 and Day 11 of presentation. Infiltrates increased to 2.8 mm X 4.1 mm and hypopyon appeared on Day 14. Topical natamycin 5% and amphotericin B 0.15% every one hour were added after epithelial debridement. Systemic voriconazole was continued for 20 days. Infiltrates kept on increasing with onset of tissue necrosis [Fig. 3].

Bottom Line: Full-thickness patch graft was done to arrest progressive necrosis.There was no recurrence in one-year follow-up.Present case illustrates the therapeutic challenge in fungal tunnel infections and possibility of voriconazole-resistant Aspergillus species.

View Article: PubMed Central - PubMed

Affiliation: Sanjivni Eye Care, Model Town, Ambala, Haryana, India.

ABSTRACT
A 44-year-old man presented 28 days after cataract surgery (phacoemulsification) in right eye with multiple pinpoint infiltrates in posterior stroma at cataract surgery wound site. Visual acuity was 20/60. Corneal scraping from the floor of the corneal tunnel revealed fungus which was later identified to be Aspergillus flavus. The patient was started on oral voriconazole 200 mg twice daily and topical voriconazole 1% every hour. Two intracameral injections of voriconazole (50 micrograms/ 0.1 ml) were given 72 h apart, five days after starting initial therapy. Infiltrates increased in size and density in spite of 20 days of voriconazole therapy. Full-thickness patch graft was done to arrest progressive necrosis. Four months after surgery, patient had 20/60 best-corrected visual acuity. There was no recurrence in one-year follow-up. Present case illustrates the therapeutic challenge in fungal tunnel infections and possibility of voriconazole-resistant Aspergillus species.

Show MeSH
Related in: MedlinePlus