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Aspergillus keratitis after deep anterior lamellar keratoplasty.

Sadigh AL, Shenasi A, Mortazavi SZ, Morsali SM - J Ophthalmic Vis Res (2014 Jul-Sep)

View Article: PubMed Central - PubMed

Affiliation: Depatment of Ophthalmology, Nikookari Eye Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.

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A 17-year-old female with a several-year history of bilateral keratoconus was visited about 1 year prior to deep anterior lamellar keratoplasty (DALK) in her right eye (OD)... The patient underwent DALK in her right eye; a recipient corneal bed size of 7.50 mm received a 7.75 mm graft, which was preserved in optisol solution and had been obtained from a 39-year-old male donor died from trauma... Postoperatively, the patient received betamethasone eye drops (every 4 hours), chloramphenicol eye drops (every 6 hours) and preservative-free artificial tears (every 2 hours)... One week post operatively, the patient was found to have moderately red right eye and on examination, mild melting of the graft was observed at 12-1.50 o’clock position... The double running sutures seemed a little tight; however, no gross infiltration was noted and the anterior chamber did not show apparent cellular reaction... Subsequently, frequency of the lubricant eye drops was increased, however her ocular findings did not improve much after 3 days... In order to prevent corneal drying and provide better lubrication, lateral blepharorrhaphy was done for the right eye... One week later, she was found to have interface infiltration and increased graft melting at the same site described above... Three weeks after surgery, the patient underwent a second surgery, therapeutic penetrating keratoplasty, during which routine cultures were repeated and the excised graft tissue was sent for histopathalogic and microbiologic exams... Three months after DALK [Figure 3], the patient had a quiet eye with uncorrected VA of 3/10 and signs of cataract development; intraocular pressure of the eye was 16 mmHg at this visit... Fungal keratitis is one of the most difficult forms of microbial keratitis for the ophthalmologist to diagnose and treat successfully... In summary, fungal infection after DALK surgery should be considered among the differential diagnosis in patients who present with interface infiltrate and corneal melting even in the early postoperative period.

No MeSH data available.


Right eye of the patient 1 week after therapeutic penetrating keratoplasty and antifungal therapy.
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Figure 2: Right eye of the patient 1 week after therapeutic penetrating keratoplasty and antifungal therapy.

Mentions: Three weeks after surgery, the patient underwent a second surgery, therapeutic penetrating keratoplasty, during which routine cultures were repeated and the excised graft tissue was sent for histopathalogic and microbiologic exams. The culture was reported positive for aspergillus on the 2nd postoperative day when amphotricin B 0.2% drops every hour and oral itraconazole 100 mg twice daily were started for the patient. One week after initiation of antifungal therapy, the improvement was so drastic that the patient was discharged from the hospital [Figure 2], with maintenance dosage of systemic and local antifungal agents which was gradually tapered over the following 2 months. Three months after DALK [Figure 3], the patient had a quiet eye with uncorrected VA of 3/10 and signs of cataract development; intraocular pressure of the eye was 16 mmHg at this visit.


Aspergillus keratitis after deep anterior lamellar keratoplasty.

Sadigh AL, Shenasi A, Mortazavi SZ, Morsali SM - J Ophthalmic Vis Res (2014 Jul-Sep)

Right eye of the patient 1 week after therapeutic penetrating keratoplasty and antifungal therapy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4307653&req=5

Figure 2: Right eye of the patient 1 week after therapeutic penetrating keratoplasty and antifungal therapy.
Mentions: Three weeks after surgery, the patient underwent a second surgery, therapeutic penetrating keratoplasty, during which routine cultures were repeated and the excised graft tissue was sent for histopathalogic and microbiologic exams. The culture was reported positive for aspergillus on the 2nd postoperative day when amphotricin B 0.2% drops every hour and oral itraconazole 100 mg twice daily were started for the patient. One week after initiation of antifungal therapy, the improvement was so drastic that the patient was discharged from the hospital [Figure 2], with maintenance dosage of systemic and local antifungal agents which was gradually tapered over the following 2 months. Three months after DALK [Figure 3], the patient had a quiet eye with uncorrected VA of 3/10 and signs of cataract development; intraocular pressure of the eye was 16 mmHg at this visit.

View Article: PubMed Central - PubMed

Affiliation: Depatment of Ophthalmology, Nikookari Eye Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

A 17-year-old female with a several-year history of bilateral keratoconus was visited about 1 year prior to deep anterior lamellar keratoplasty (DALK) in her right eye (OD)... The patient underwent DALK in her right eye; a recipient corneal bed size of 7.50 mm received a 7.75 mm graft, which was preserved in optisol solution and had been obtained from a 39-year-old male donor died from trauma... Postoperatively, the patient received betamethasone eye drops (every 4 hours), chloramphenicol eye drops (every 6 hours) and preservative-free artificial tears (every 2 hours)... One week post operatively, the patient was found to have moderately red right eye and on examination, mild melting of the graft was observed at 12-1.50 o’clock position... The double running sutures seemed a little tight; however, no gross infiltration was noted and the anterior chamber did not show apparent cellular reaction... Subsequently, frequency of the lubricant eye drops was increased, however her ocular findings did not improve much after 3 days... In order to prevent corneal drying and provide better lubrication, lateral blepharorrhaphy was done for the right eye... One week later, she was found to have interface infiltration and increased graft melting at the same site described above... Three weeks after surgery, the patient underwent a second surgery, therapeutic penetrating keratoplasty, during which routine cultures were repeated and the excised graft tissue was sent for histopathalogic and microbiologic exams... Three months after DALK [Figure 3], the patient had a quiet eye with uncorrected VA of 3/10 and signs of cataract development; intraocular pressure of the eye was 16 mmHg at this visit... Fungal keratitis is one of the most difficult forms of microbial keratitis for the ophthalmologist to diagnose and treat successfully... In summary, fungal infection after DALK surgery should be considered among the differential diagnosis in patients who present with interface infiltrate and corneal melting even in the early postoperative period.

No MeSH data available.