amphotericin-b and Eye-Injuries--Penetrating

We report our experience in treating two cases of Scedosporium apiospermum keratitis and provide a review of basic scientific and clinical data regarding the treatment of this visually devastating disease.. We present a case report and literature review.. A 35-year-old woman and a 73-year-old man both reported pain, redness, and a foreign body sensation in the eye after trauma. They were initially treated with antibacterials. When cultures were positive for S. apiospermum, the first patient was treated with fluconazole and amphotericin with good results. The second was treated with fluconazole and natamycin, but the infection persisted and the eye was eventually enucleated. Review of the literature showed variable responsiveness of S. apiospermum to antifungal treatment.. It is difficult to predict how S. apiospermum keratitis will respond to treatment, but miconazole appears to be useful in conjunction with other antifungals. Voriconazole shows promise as an effective alternative.

Topics: Adult; Aged; Amphotericin B; Cornea; Corneal Injuries; Drug Therapy, Combination; Eye Enucleation; Eye Infections, Fungal; Eye Injuries, Penetrating; Female; Fluconazole; Humans; Keratitis; Male; Mycetoma; Natamycin; Scedosporium

Topics: Amphotericin B; Antifungal Agents; Ascomycota; Cornea; Corneal Injuries; Endophthalmitis; Eye Foreign Bodies; Eye Infections, Fungal; Eye Injuries, Penetrating; Humans; Keratoplasty, Penetrating; Male; Middle Aged; Mycoses; Sclera; Ultrasonography; Visual Acuity; Vitreous Body; Young Adult

The purpose of this study was to report a case of Phomopsis fungal keratitis that was diagnosed 2 months after a rose thorn injury that occurred while gardening.. The authors conducted a retrospective case report with literature review.. Deep stromal keratitis with extension of hyphae through Descemet's membrane was treated by therapeutic keratoplasty combined with oral and topical antifungal medications. The causative organism, a Phomopsis species, was identified by culture of the surgical specimens. Phomopsis, a plant fungus, has not been previously reported as a cause of human fungal keratitis. One year after the initial surgery, visual rehabilitation was accomplished with a repeat cornea transplant and cataract extraction with return of vision to 20/25.. Advanced fungal keratitis can be successfully treated by a combination of surgery to debulk the infectious organisms and pre- and postoperative medical therapy. Prompt recognition of fungal keratitis will increase the likelihood of cure. Phomopsis species, ubiquitous plant fungi, can cause infectious keratitis in humans.

Topics: Administration, Oral; Amphotericin B; Antifungal Agents; Ascomycota; Cataract; Cataract Extraction; Corneal Ulcer; Eye Infections, Fungal; Eye Injuries, Penetrating; Gardening; Humans; Keratitis; Keratoplasty, Penetrating; Male; Middle Aged; Plant Diseases; Postoperative Care; Pyrimidines; Reoperation; Triazoles; Voriconazole

To study the incidence, clinical presentation, and the response of anti-fungals in cases of fungal endophthalmitis following open globe injury.. This is a prospective study of eight cases of post-traumatic fungal endophthalmitis among 110 patients who presented to us with open globe injury between August 2003 and January 2005. Patients with panophthalmitis were eviscerated and rest received intravitreal amphotericin B. Pars plana vitrectomy along with intravitreal miconazole was given in patients with inadequate response to intravitreal amphotericin.. Two patients had panophthalmitis at the time of presentation and were eviscerated. Six different organisms were isolated from the culture of intraocular specimen of eight patients. The yield of vitreous aspirate was 87.5% and that of aqueous aspirate was 66.6%. Aspergillus sp. and Fusarium sp. were isolated in 62.5% of cases. Minimum inhibitory concentration of amphotericin B and miconazole was less than 3 microg/ml for all organisms except for Paecilomyces lilacinus and Fusarium solani, respectively. In total, 37.5% of patient had final visual acuity of 20/400 or better.. Fungal endophthalmitis is a relatively rare complication of open globe injury. The final visual outcome after fungal endophthalmitis is dismal. Aspergillus fumigatus was found to be the most virulent organism. All organisms were found to be sensitive to amphotericin B, except P. lilacinus, which was sensitive to miconazole. Repeated intravitreal injection may be required to control the infection. The virulence of the organism and the site of injury are the main determinants of final visual outcome.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Endophthalmitis; Eye Infections, Fungal; Eye Injuries, Penetrating; Female; Humans; Male; Miconazole; Microbial Sensitivity Tests; Middle Aged; Prospective Studies

Topics: Amphotericin B; Cornea; Corneal Injuries; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Bacterial; Eye Injuries, Penetrating; Fluconazole; Gram-Negative Bacterial Infections; Humans; Male; Middle Aged; Ofloxacin; Stenotrophomonas maltophilia; Visual Acuity

Topics: Absidia; Accidents, Occupational; Adult; Amphotericin B; Antifungal Agents; Corneal Ulcer; Eye Foreign Bodies; Eye Injuries, Penetrating; Humans; Male; Mucormycosis

To report a case of recurrent fungal sclerokeratitis and endophthalmitis with a very successful outcome due to aggressive combined surgical and medical therapy. To discuss the management of this potentially devastating infection.. A 65-year-old man presented with 6 months of left eye redness and irritation after injury from organic matter propelled from an airboat. Initially, he had been treated with foreign body removal, antibiotics, and steroids. He was diagnosed with reactive sclerokeratitis at presentation and was treated with steroids. However, when he did not improve, cultures were obtained and Acremonium species filamentous fungi was identified. Despite treatment with appropriate topical and systemic antifungals, his fungal sclerokeratitis progressed to endophthalmitis. Two therapeutic penetrating keratoplasties (PKs) with iridectomy and intraocular amphotericin B were necessary to eradicate the fungal infection.. Visual acuity was restored to 20/25-3 with correction 9 months after initial presentation. There was no recurrence of fungal infection after the second therapeutic PK.. The possible reasons for recurrence of fungal infection are discussed. The role of timely and aggressive medical and surgical intervention for fungal sclerokeratitis and endophthalmitis in restoring excellent vision is emphasized.

Topics: Acremonium; Aged; Amphotericin B; Antifungal Agents; Endophthalmitis; Eye Foreign Bodies; Eye Infections, Fungal; Eye Injuries, Penetrating; Humans; Keratitis; Keratoplasty, Penetrating; Male; Secondary Prevention; Visual Acuity