amphotericin-b and Keratitis

Colletotrichum species are known as important pathogens of plants with an impact on crop production. Some of these species are also known as a cause of rare ophthalmic infections in humans. A case of keratitis caused by Colletotrichum dematium after corneal trauma in a 56-year-old woman is presented. Infection was diagnosed based on positive microscopy and culture. The fungal isolate was identified by morphological characteristics and DNA sequencing of the ITS rDNA region, β-tubulin (tub2) and glyceraldehyde-3-phosphate dehydrogenase (gapdh) genes. The patient responded well to topical therapy with amphotericin B combined with intravenous amphotericin B but improvement was associated with the corneal collagen cross-linking. The review of the literature revealed another 13 cases of C. dematium keratitis, all but one patient having at least one keratitis risk factor in their history. Almost all patients (n = 12) were treated with topical polyene antibiotics (natamycin or amphotericin B), improvement and cure were achieved in eight of them.

Topics: Administration, Topical; Adolescent; Adult; Amphotericin B; Antifungal Agents; Colletotrichum; DNA, Ribosomal Spacer; Eye Injuries; Female; Glyceraldehyde-3-Phosphate Dehydrogenase (Phosphorylating); Humans; Keratitis; Male; Microbiological Techniques; Middle Aged; Molecular Diagnostic Techniques; Mycoses; Sequence Analysis, DNA; Treatment Outcome; Tubulin; Young Adult

Mycotic keratitis or keratomycosis is a fungal infection with global distribution. The dominant aetiology of this disease varies based on geographical origin, socioeconomic status, and climatic condition. Generally, Aspergillus spp. and Fusarium spp. are common in tropical and subtropical regions and Candida spp. are dominant in temperate areas. Demonstration of fungal elements in microscopic examination besides the isolation of fungi in culture is the gold standard of laboratory diagnosis. As the culture is a time-consuming procedure, other approaches such as in vivo confocal microscopy which produces real-time imaging of corneal tissue and molecular techniques have been developed to facilitate rapid diagnosis of fungal keratitis. The first choice of treatment is topical natamycin, although topical amphotericin B is the best choice for Aspergillus and Candida keratitis. Regarding the diversity of fungal aetiology and the emergence of drug resistance in some genera and species, proper identification using molecular methods and antifungal susceptibility testing could provide useful data. Furthermore, as the better efficacy of combination therapy in comparison to monotherapy is reported, in vitro determination of interactions between various drugs seem informative. This review aims to provide a general and updated view on the aetiology, risk factors, epidemiology, clinical and laboratory diagnosis, and management of fungal keratitis.

Topics: Administration, Topical; Amphotericin B; Antifungal Agents; Climate; Drug Therapy, Combination; Eye Infections, Fungal; Fungi; Global Health; Humans; Keratitis; Microbiological Techniques; Microscopy; Molecular Diagnostic Techniques; Natamycin; Risk Factors

To describe a rare case of early-onset Candida parapsilosis infection after laser in situ keratomileusis (LASIK) and review the published reports of post-LASIK fungal infections.. A 32-year-old woman presented with interface infiltration in the central interface in the right eye 2 days after LASIK surgery. The right eye flap was lifted, and the opacities were scraped. Two days later, a 3- x 3-mm-dense oval opacity and diffuse hazes were noted. Surgical intervention was arranged because of suspicion of interface infectious keratitis.. After an apparent post-LASIK keratitis with related interface inflammation failed to respond to medical therapy, corneal culture results were positive for C. parapsilosis 2 weeks 6 days after presentation. The patient was started on topical drops of amphotericin B 0.15% every hour after the smear showed the presence of yeast. The opacities decreased, and the topical antifungal drops were tapered. One month later, her uncorrected visual acuity recovered to 20/20.. Candida parapsilosis interface keratitis after LASIK may occur in the early phase. Early diagnosis and proper treatment can result in good outcome.

Topics: Adult; Amphotericin B; Antifungal Agents; Candidiasis; Corneal Opacity; Drug Administration Schedule; Female; Humans; Keratitis; Keratomileusis, Laser In Situ; Ophthalmic Solutions

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: Administration, Topical; Amphotericin B; Anemia, Aplastic; Anti-Infective Agents; Benzamidines; Chronic Disease; Conjunctivitis; Conjunctivitis, Allergic; Corneal Injuries; Dermatitis, Contact; Drug Eruptions; Epithelium; Humans; Idoxuridine; Keratitis; Stevens-Johnson Syndrome; Sulfonamides; Wound Healing

To determine if there is a benefit to adjuvant corneal crosslinking (CXL) and to compare natamycin versus amphotericin B for filamentous fungal keratitis.. Outcome-masked, 2×2 factorial design, randomized controlled clinical trial.. Consecutive patients presenting with moderate vision loss from a smear-positive fungal ulcer at Aravind Eye Hospital, Madurai, India.. Study eyes were randomized to 1 of 4 treatment combinations using an adaptive randomization protocol. The treatment arms included (1) topical natamycin 5% alone, (2) topical natamycin 5% plus CXL, (3) topical amphotericin B 0.15% alone, and (4) topical amphotericin 0.15% plus CXL.. The primary outcome of the trial was microbiological cure at 24 hours on repeat culture. Secondary outcomes included best spectacle-corrected visual acuity (BSCVA) at 3 weeks and 3 months, percentage of study participants with epithelial healing at 3 days, 3 weeks, and 3 months, infiltrate or scar size at 3 weeks and 3 months, 3-day smear and culture, and adverse events.. Those randomized to CXL regardless of medication (topical natamycin or amphotericin) had 1.32-fold increased odds of 24-hour culture positivity, although this was not statistically significant (95% confidence interval [CI], 0.57-3.06; P = 0.51). We were also unable to find a difference in 24-hour culture positivity between those randomized to amphotericin and those randomized to natamycin when evaluating as a group regardless of whether or not they received CXL (coefficient 1.10; 95% CI, 0.47-2.54; P = 0.84). The BSCVA was approximately 0.22 logarithm of the minimum angle of resolution (logMAR) (2.2 Snellen lines) worse on average at 3 weeks among those receiving CXL regardless of medication (95% CI, -0.04 to 0.40; P = 0.04) and 0.32 logMAR (3.2 Snellen lines) worse visual acuity at 3 months after controlling for baseline visual acuity (95% CI, 0.03-0.54; P = 0.02). There was no difference in infiltrate or scar size, percentage of epithelialized or adverse events when comparing CXL with no CXL or the 2 topical medications.. There appears to be no benefit of adjuvant CXL in the primary treatment of moderate filamentous fungal ulcers, and it may result in decreased visual acuity.

Topics: Administration, Topical; Adult; Aged; Amphotericin B; Antifungal Agents; Cross-Linking Reagents; Eye Infections, Fungal; Female; Humans; Keratitis; Male; Middle Aged; Natamycin; Riboflavin; Ultraviolet Rays; Visual Acuity

The study was aimed at evaluating the treatment of fungal keratitis using a combination therapy of a low concentration of topical amphotericin B (0.2 mg/mL) eye drops together with subconjunctival injections of 2 mg/mL of fluconazole.. The study was carried out in the Ophthalmology Department of Zagazig University Hospital and included 12 patients with 12 pairs of eyes with resistant corneal ulcers that had the following clinical features suggesting fungal keratitis: thick elevated ulcer, feathery edge, and gutter formation. Cultures of corneal specimens were grown on Sabouraud agar medium. Topical amphotericin B eye drops in a concentration of 0.2 mg/mL in dextrose 5% were used every 2 hours for 21 days together with subconjunctival injections of fluconazole 2 mg/mL.. Among the eyes subjected to culture of corneal specimens, 8 eyes had positive results: Candida was detected in 5 eyes (66%) and filamentous fungi grew from the cultures of 3 eyes. Nine eyes improved as a result of treatment, showing complete healing of the ulcers (75%). Three cases showed no improvement (25%); 2 cases developed endophthalmitis; and 1 case was negative. A single case with corneal perforation had negative results on culture.. The use of a combination of topical amphotericin B eye drops at a concentration of 0.2 mg/mL in dextrose 5% with subconjunctival injection of fluconazole 2 mg/mL had the advantage of a lower incidence of the complications of local use of amphotericin B and a broader spectrum of antifungal coverage. This study reports a relatively high success rate of healing of fungal keratitis, with a significant reduction of the potential side effects of the local use of antifungal agents.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Candida; Conjunctiva; Corneal Ulcer; Drug Therapy, Combination; Eye Infections, Fungal; Fluconazole; Fungi; Humans; Injections; Keratitis; Middle Aged; Ophthalmic Solutions; Young Adult

The aim of the study was to compare the use of combination therapy of topical amphotericin B (0.5 mg/mL) eye drops together with subconjunctival injection of fluconazole (2 mg/mL) with the use of topical amphotericin B (0.5 mg/mL) eye drops alone in dealing with cases of fungal keratitis.. The study was performed in the Ophthalmology Department, Zagazig University and included 48 eyes of 48 patients who presented clinically with fungal keratitis. Laboratory investigations were performed, including direct microscopy of corneal smear using gram staining and culture of corneal specimens using Saboraud agar media and bacterial agar media. According to laboratory results, cases were classified into 2 groups: group 1 comprising 24 eyes treated by a combination therapy of topical amphotericin B eye drops (0.5 mg/mL) with subconjunctival injection of fluconazole (2 mg/mL) and group 2 comprising 24 eyes treated by topical amphotericin B eye drops (0.5 mg/mL) alone.. Direct corneal smear for all 48 eyes included in the study revealed 18 eyes (38%) with positive fungal spores, 3 of them (6%) with gram-positive bacterial infection. Fungal culture of corneal specimens revealed positive result in 36 eyes (75%), including the positive corneal smear cases showing Candida in 12 eyes and filamentous fungi in 24 eyes. Treatment by a combination therapy in group 1 revealed statistically significant result (P < 0.05) of healing of corneal ulcers in 20 eyes (83%), with a mean duration of healing of 31 days (standard deviation [SD] +/-3), in comparison to group 2 with monotherapy, which revealed 16 eyes (67%), with a mean duration of healing of 37 days (SD +/-2).. Combination therapy of topical amphotericin B eye drops with subconjunctival injection of fluconazole was more efficient (according to the percentage and the duration of healing of the ulcers) than the use of topical amphotericin B eye drops alone in dealing with cases of fungal keratitis--it may be contributed to the broad spectrum of the antifungal agents of the combination therapy than the monotherapy.

Topics: Administration, Topical; Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Candida; Conjunctiva; Drug Therapy, Combination; Eye Infections, Fungal; Female; Fluconazole; Follow-Up Studies; Fungi; Humans; Injections; Keratitis; Male; Middle Aged; Prospective Studies; Young Adult

The aim of this study was to report the first case of mycotic keratitis caused by Botryosphaeria dothidea .. A 29-year-old man developed a fungal infection after being hit with chestnut thorns in the left eye. In vivo confocal microscopy, microbial culture, and next-generation sequencing (NGS) were used in the diagnosis of mycotic keratitis.. The patient was provisionally diagnosed with mycotic keratitis based on IVCM and promptly received local and systemic antifungal treatment with voriconazole and amphotericin B. Although microbial culture failed to identify the pathogen, NGS revealed B. dothidea as the causative agent. Although the infection was quickly contained, corneal perforation still occurred. Owing to the lack of fresh donor corneas, the patient underwent multilayer amniotic membrane and conjunctival pedicle graft surgery. The infection was successfully controlled, and during the 6-month follow-up, the cornea remained clear in the inferotemporal optical zone.. We report a novel phytopathogen- B. dothidea -causing mycotic keratitis . Our case indicates that B. dothidea responds well to voriconazole and amphotericin therapy. This case broadens the spectrum of fungal keratitis and highlights the application of NGS in identifying molds.

Topics: Adult; Amphotericin B; Antifungal Agents; Ascomycota; Corneal Ulcer; Eye Infections, Fungal; Humans; Keratitis; Male; Voriconazole

We present a rare case of recalcitrant fungal keratitis caused by Coniochaeta mutabilis, successfully managed with a course of oral, topical, intrastromal, and intracameral antifungals. A 57-year-old male on their fourth week of treatment for presumed left herpes simplex keratitis presented to clinic with severe left-sided foreign body sensation after gardening in his yard. On examination, a white corneal plaque was observed at 8 o'clock, shown to be a dense collection of fungal hyphae on confocal microscopy. Corneal cultures revealed yeast-like cells, initially identified as Kabatiella zeae by matching 100% identity with K. zeae strains CBS 767.71 and CBS 265.32 in BLASTn search using the internal transcribed spacer (ITS) sequence. Treated for over four months with topical amphotericin B and oral voriconazole without improvement, recourse to intrastromal and intracameral amphotericin B injections, coupled with the application of cyanoacrylate glue to the lesion and a bandage contact lens, led to eventual resolution. The patient subsequently underwent cataract surgery, achieving a BCVA of 20/20 in the eye. Surprisingly, upon further sequence analyses of combined ITS and large subunit ribosomal ribonucleic acid (LSU) and investigation of the K. zeae German strain CBS 767.71, the organism was revealed to be Coniochaeta mutabilis (formerly Lecythospora mutabilis). This means that the correct name for CBS 767.71 and CBS 265.32 is C. mutabilis and should be corrected in the GenBank record to avoid misleading identification in the future. This case also underscores the urgent unmet need for improved molecular diagnostic modalities in the care of corneal infections.

Topics: Amphotericin B; Antifungal Agents; Corneal Ulcer; Eye Infections, Fungal; Humans; Keratitis; Male; Middle Aged; Voriconazole

The study aimed to evaluate the clinical aspects, molecular identification, biofilm formation, and antifungal susceptibility profile of Candida species isolated from fungal keratitis. Thirteen Candida isolates from 13 patients diagnosed with Candida keratitis were retrieved and grown in pure culture. Species identification was performed by micromorphology analysis and ITS-rDNA sequencing. The broth microdilution method tested the minimum inhibitory concentration (MIC) of four antifungal drugs (fluconazole, amphotericin B, voriconazole, and anidulafungin). The biofilms were cultured and incubated with antifungal drugs for 24 h. The XTT reduction assay measured the biofilm activity. Biofilm MICs were calculated based on a 50% reduction in metabolic activity compared with the activity of the drug-free control. Among isolates, two were C. albicans, 10 were C. parapsilosis (sensu stricto), and one was C. orthopsilosis. All isolates were classified as susceptible or intermediate to all four antifungal drugs. Four isolates were very low biofilm producers (30%). Nine isolates were biofilm producers, and all biofilm samples were unsusceptible to all drugs tested. Previous ocular surgery was the most common underlying condition for fungal keratitis (84.6%), and C. parapsilosis was the most frequent Candida species (76.9%). Four patients (30.7%) needed keratoplasty, whereas two (15.3%) required evisceration. The biofilm formation ability of Candida isolates decreased antifungal susceptibility compared with planktonic cells. Despite in vitro antifungal susceptibility, almost half of the patients were unresponsive to clinical treatment and needed surgery.

Topics: Amphotericin B; Antifungal Agents; Biofilms; Candida; Candida albicans; Candida parapsilosis; Drug Resistance, Fungal; Humans; Keratitis; Microbial Sensitivity Tests

Nowadays, the co-infection of different classes of pathogens is a major concern. The objective of this study was to develop a successful therapy for keratitis caused by the co-infection of Candida sp. with Pseudomonas sp, which is difficult to cure. The study is based on a 47 years old male farmer showing redness and watering in the right eye for 15-days. ; Methods: The microbiological examination was performed to isolate the causative organisms, i.e. Pseudomonas aeruginosa and Candida albicans. They were cultured separately along with their co-culture and treated with ciprofloxacin and amphotericin B during the growing stage to predict a definite cure. ; Results: Scanning electron microscope (SEM) results confirmed the inter-specific interaction between the two different types of microorganisms. Amphotericin-B and Ciprofloxacin showed the least MIC value for both organisms in co-culture. ; Conclusion: Treatment with Amphotericin-B and 5% ciprofloxacin effectively hindered the growth of Pseudomonas aeruginosa and Candida albicans, the co-infection of which caused keratitis. This therapy may be successfully implied for such cases of co-infection in the future.

Topics: Amphotericin B; Candida albicans; Coinfection; Humans; Keratitis; Male; Middle Aged; Pseudomonas aeruginosa

Infectious keratitis is the main cause of preventable blindness worldwide, with about 1.5-2.0 million new cases occurring per year. This inflammatory response may be due to infections caused by bacteria, fungi, viruses or parasites. Fungal keratitis is a poorly studied health problem.. This study aimed to identify a new fungal species by molecular methods and to explore the possible efficacy of the three most common antifungals used in human keratitis in Mexico by performing in vitro analysis. The capacity of this pathogen to cause corneal infection in a murine model was also evaluated.. The fungal strain was isolated from a patient with a corneal ulcer. To identify the fungus, taxonomic and phylogenetic analyses (nrDNA ITS and LSU data set) were performed. An antifungal susceptibility assay for amphotericin B, itraconazole and voriconazole was carried out. The fungal isolate was used to develop a keratitis model in BALB/c mice; entire eyes and ocular tissues were preserved and processed for histopathologic examination.. This fungal genus has hitherto not been reported with human keratitis in Mexico. We described a new species Purpurecillium roseum isolated from corneal infection. P roseum showed resistance to amphotericin B and itraconazole and was sensitive to voriconazole. In vivo study demonstrated that P roseum had capacity to developed corneal infection and to penetrate deeper corneal tissue. The global change in fungal infections has emphasised the need to develop better diagnostic mycology laboratories and to recognise the group of potential fungal pathogens.

Topics: Aged; Amphotericin B; Animals; Antifungal Agents; Cornea; DNA, Fungal; Drug Resistance, Fungal; Female; Humans; Hypocreales; Itraconazole; Keratitis; Mexico; Mice; Mice, Inbred BALB C; Microbial Sensitivity Tests; Mycological Typing Techniques; Mycoses; Phylogeny; Voriconazole

A case of fungal keratitis due to Coprinellus radians is reported. To our knowledge, fungal keratitis caused by this species was rare. Fungal hyphae were detected in corneal scrapings, and isolates were identified by morphology and by sequencing the internal transcribed spacer region of ribosomal DNA. The patient was treated with systemic and local antifungal therapy for 5 days, and lamellar keratoplasty was performed after no obvious improvement in symptoms. The in vitro antifungal susceptibilities of the case strain were tested for six antifungal agents. The results showed that 5-fluorouracil was resistant, fluconazole was moderately sensitive, and the other drugs assayed (amphotericin B, posaconazole, itraconazole and voriconazole) were highly effective against this fungus.

Topics: Agaricales; Amphotericin B; Antifungal Agents; Corneal Transplantation; Corneal Ulcer; DNA, Fungal; DNA, Ribosomal Spacer; Eye Infections, Fungal; Female; Humans; Hyphae; Keratitis; Microbial Sensitivity Tests; Middle Aged; Triazoles

To evaluate the clinical outcomes of combined intrastromal voriconazole and intrastromal amphotericin B for the treatment of persistent fungal keratitis.. Patients who received combined corneal intrastromal voriconazole (0.05 mg/0.1 mL) and intrastromal liposomal amphotericin B (0.01 mg/0.1 mL) injections in addition to topical therapy for treatment of persistent fungal keratitis were included in the study. Persistence was described as no improvement or progression in the clinical findings despite treatment with combined topical voriconazole (1 mg/0.1 mL) and topical amphotericin B drops (0.15 mg/0.1 mL) hourly for at least 10 days. The healing of keratitis was considered as the complete closure of epithelial defect with complete resolution of a corneal infiltrate.. Thirty-two eyes of 32 patients who met the inclusion criteria were included in this study. Predominant organisms in fungal isolates were Aspergillus species. Combination therapy of intrastromal amphotericin B and intrastromal voriconazole in addition to topical therapy resulted in complete resolution of persistent fungal keratitis in 28 (87.5%) patients. The mean number of intrastromal injections was 9.3±6.4 and ranged from 1 to 18. The mean best-corrected visual acuity values improved from 2.17±0.43 to 1.76±0.77 logarithm of the minimum angle of resolution units (P=0.003). The mean duration of complete epithelial closure was 45.3±16.3 days. Four patients required therapeutic penetrating keratoplasty because of persistence of fungal keratitis (3 patients) and progression of keratitis (1 patient). There was no need for evisceration.. Combination therapy with intrastromal voriconazole and intrastromal amphotericin B may be an effective adjunct treatment for persistent fungal keratitis.

Topics: Amphotericin B; Antifungal Agents; Eye Infections, Fungal; Humans; Keratitis; Voriconazole

Topics: Amphotericin B; Antifungal Agents; Contact Lenses, Extended-Wear; Eye Infections, Fungal; Female; Humans; Keratitis; Voriconazole; Young Adult

To determine the concentration of amphotericin B that would be both effective against Candida albicans contamination and safe for corneal endothelial cells (CECs) in cold storage conditions.. Triplicate media cultures were inoculated with 10 colony-forming units (CFUs)/mL of C. albicans (American Type Culture Collection 10231), supplemented with amphotericin B (0-20 μg/mL), stored in cold conditions (2°C-8°C) for 72 hours, and analyzed quantitatively for CFUs. C. albicans concentration in each sample was determined initially and after 6, 24, 48, and 72 hours of storage. CEC mitochondrial function (oxygen consumption rate), apoptosis, and necrosis were examined in donor corneas after 7 days of amphotericin B exposure and compared with untreated controls. CEC viability was also examined by calcein-AM staining and Fiji segmentation after 72 hours or 2 weeks of amphotericin B exposure to mimic potential eye bank practices.. Amphotericin B concentrations of 1.25, 2.5, and 5.0 μg/mL resulted in 0.47, 1.11, and 1.21 log10 CFU reduction after only 6 hours of cold storage and continued to decrease to 3.50, 3.86, and 4.49 log10 reductions after 72 hours, respectively. By contrast, amphotericin B 0.255 µg/mL showed only 1.01 log10 CFU reduction after 72 hours of incubation. CEC mitochondrial function and viability did not differ in donor corneas exposed to amphotericin B ≤2.59 μg/mL compared with the controls.. Optimal efficacy of amphotericin B against C. albicans is achieved in cold storage conditions at concentrations ≥1.25 μg/mL, and 2.5 μg/mL reduces Candida contamination by >90% after 6 hours of cold storage without sacrificing CEC health.

Topics: Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis; Dose-Response Relationship, Drug; Endothelium, Corneal; Eye Banks; Eye Infections, Fungal; Humans; Keratitis; Microbial Sensitivity Tests; Organ Preservation; Surgical Wound Infection

Commensalism coinfection of pathogens has seriously jeopardized human health. Currently, Kunitzin-RE, as an amphibian-derived bioactivity peptide, is regarded as a potential antimicrobial candidate. However, its antimicrobial properties were unsatisfactory. In this study, a set of shortened variants of Kunitzin-RE was developed by the interception of a peptide fragment and single-site mutation to investigate the effect of chain length, positive charge, hydrophobicity, amphipathicity, and secondary structure on antimicrobial properties. Among them, W8 (AARIILRWRFR) significantly broadened the antimicrobial spectrum and showed the highest antimicrobial activity (GM

Topics: Amino Acid Sequence; Animals; Anti-Bacterial Agents; Antifungal Agents; Antimicrobial Cationic Peptides; Candida albicans; Cell Membrane; Cell Membrane Permeability; Coinfection; Drug Design; Escherichia coli; Eye Infections, Fungal; Keratitis; Mice; Microbial Sensitivity Tests; Protein Conformation, alpha-Helical; Protein Engineering; RAW 264.7 Cells; Salmonella typhimurium; Staphylococcus aureus

Topical application of poorly water-soluble antibiotics cannot achieve the desired therapeutic concentration within cornea. The purpose of this study was to fabricate, characterize and evaluate in-vivo effectiveness of amphotericin B (AmB) containing microneedle ocular patch (MOP) against fungal keratitis. MOP containing free or liposomal AmB was fabricated using micromolding technique to mimic contact lens. MOPs were prepared using dissolvable polymeric matrix including polyvinyl alcohol and polyvinyl pyrrolidone. AmB loaded MOP were studied for their physical and mechanical properties, drug loading and dissolution rate, corneal insertion and drug permeability. MOP loaded with 100 µg AmB had a compression strength of 35.1 ± 6.7 N and required an insertional force of 1.07 ± 0.17 N in excised human cornea. Ex-vivo corneal permeation studies revealed significant enhancement in AmB corneal retention with the application of MOP compared with free AmB or liposomal AmB application. Furthermore, AmB loaded MOP application significantly (P < 0.05) reduced the Candida albicans load within cornea as evaluated in both ex-vivo model and in-vivo rabbit infection model. Histological examination showed that AmB MOP treatment improved the epithelial and stromal differentiation of corneal membrane. AmB containing MOPs can be developed as minimally invasive corneal delivery device for effective treatment of fungal keratitis.

Topics: Administration, Ophthalmic; Amphotericin B; Animals; Antifungal Agents; Candida albicans; Candidiasis; Compressive Strength; Disease Models, Animal; Dosage Forms; Drug Compounding; Drug Delivery Systems; Eye Infections, Fungal; Humans; Keratitis; Male; Miniaturization; Needles; Permeability; Phosphatidylcholines; Polyvinyl Alcohol; Povidone; Rabbits

A 54-year-old Caucasian woman presented with corneal ulcer of the right eye of 4 weeks duration after scratching her cornea while removing her contact lens and artificial eye lashes. Her visual acuity was 20/32 (left eye) and finger counting (right eye). She had a 3x3 mm epithelial defect with underlying corneal oedema and hypopyon. Right eye cultures grew

Topics: Amphotericin B; Antifungal Agents; Corneal Edema; Corneal Ulcer; Eye Infections, Fungal; Female; Humans; Injections, Intraocular; Keratitis; Middle Aged; Mycoses; Paecilomyces; Recurrence; Surgical Flaps; Treatment Outcome; Visual Acuity

Topics: Administration, Topical; Amphotericin B; Antifungal Agents; Cornea; Corneal Injuries; Corneal Stroma; Eye Infections, Fungal; Female; Fluconazole; Humans; Immunocompromised Host; Keratitis; Middle Aged; Pichia; Plant Leaves; Treatment Outcome; Visual Acuity

To evaluate a new corneal cold storage medium including an antimycotic tablet (Kerasave, AL.CHI.MI.A. S.r.l.).. Kerasave and tryptone soy broth (control) were inoculated with 10 and 10 colony-forming units (CFU)/mL of 6 Candida isolates (Candida albicans [n = 4], Candida tropicalis [n = 1], and Candida glabrata [n = 1]). Minimum inhibitory concentrations (MICs) were determined using amphotericin B Etest strips. Sterile porcine corneas contaminated with 10 CFU/mL of each isolate were incubated in Kerasave and control at 4°C. Growth rate and Log10 reduction at 4°C at different time intervals were determined for liquid samples and tissue homogenates. Kerasave biocompatibility was assessed according to ISO 10993-5 and ISO 10993-10.. No C. albicans or C. tropicalis colonies were recovered from Kerasave inoculated with 10 CFU/mL after incubation for 3 days at 4°C. C. glabrata was inhibited but not killed after 3 days at 4°C. Four of the 6 strains contaminated with 10 CFU/mL demonstrated a significant ≥ 3 Log10 reduction in media and tissue homogenates within 5 days as compared to controls (p < 0.01). Amphotericin B MICs ranged from 0.19 to 0.38 μg/mL for C. albicans (n = 3) and C. tropicalis (n = 1). C. glabrata showed reduced susceptibility (0.5 μg/mL) and 1 C. albicans was resistant to amphotericin B (≥ 1 μg/mL). Kerasave was not cytotoxic, irritating, or sensitizing according to the ISO standards.. Kerasave showed high antifungal efficacy against susceptible fungal strains at 4°C in the presence and absence of corneal tissue. Resistant strains to amphotericin B were not eliminated by Kerasave. Kerasave is not cytotoxic, irritating, or sensitizing.

Topics: Amphotericin B; Animals; Antifungal Agents; Candida; Candidiasis; Cornea; Disease Models, Animal; Eye Infections, Fungal; Keratitis; Microbial Sensitivity Tests; Organ Preservation; Organ Preservation Solutions; Swine

Tintelnotia destructans is a fungal species described for the first time in 2016, which can cause infections of the nails and of the cornea. We describe the second known case worldwide of Tintelnotia destructans-associated keratitis and its therapy. A good sensitivity for amphotericin B and voriconazole was demonstrated in the resistogram for the first time and the successful clinical course was confirmed. The present case study also shows the importance of intensive diagnostics in atypical microbial keratitis.

Topics: Amphotericin B; Antifungal Agents; Eye Infections, Fungal; Humans; Keratitis; Voriconazole

To report a difficult-to-identify case of keratitis due to Fusarium solani, diagnosed with the help of exhaustive gene analysis.. A 47-year-old woman attended our hospital with a refractory corneal ulcer associated with contact lens wear in her left eye that had appeared two weeks earlier. On her initial visit, slit lamp examination revealed a small double-ringed irregular hyphate ulcer in the center of the cornea, which had no epithelial defect, suggesting fungal infection. Microscopic visualization and culture of corneal scrapings were performed repeatedly, but the results were negative. Despite intensive antifungal treatment, infiltration of the cornea worsened and therapeutic keratoplasty was performed. Specimens from a corneal button were microbiologically and histologically negative for microorganisms. During irrigation of the anterior chamber with amphotericin B, aspirated corneal infiltrations were submitted for culture and metagenomic analysis. Genes belonging to F. solani were identified by metagenomic analysis, and an isolate presumed to be a Fusarium species was cultured. Genotypic identification of the isolates confirmed F. solani.. The detection of microorganisms, especially fungi, can be extremely difficult. In difficult-to-culture cases, metagenomic analysis seems to be a promising technique for the identification of microbial pathogens.

Topics: Amphotericin B; Antifungal Agents; Cornea; Corneal Transplantation; DNA, Fungal; Eye Infections, Fungal; Female; Fusarium; Humans; Keratitis; Metagenomics; Middle Aged; Sequence Analysis, DNA

Fungal keratitis is rare in France, but could be a severe sight-threatening condition. Here, we aimed to describe the epidemiology of fungal keratitis in Réunion Island.. In a retrospective study, we analyzed 13 culture-proven keratitis episodes, occurred between January 2013 and July 2017 in the ophthalmology ward of a University Hospital, Saint-Pierre. Twelve isolates were genotyped and antifungal susceptibility testing was performed.. Corneal abrasion caused by vegetable matter was the main predisposing factor. Stromal infiltration was observed in 12 patients. Six patients did not response to medical treatment, requiring surgical care, including two enucleations surgery. Fusarium solani (n = 6) and Fusarium dimerum (n = 4) were the main fungal species involved in fungal keratitis. Clinical failures were more prevalent with F. solani infections. The lowest minimal inhibitory concentrations for Fusarium sp. were observed with voriconazole and amphotericin B.. In Reunion Island, the epidemiology of fungal keratitis is characterized by the predominance of Fusarium species, potentially involved in visual loss. This pattern is consistent with the epidemiology usually observed in tropical areas.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Corneal Injuries; Eye Infections, Fungal; Female; Fusariosis; Hospitals, University; Humans; Keratitis; Male; Middle Aged; Retrospective Studies; Reunion; Voriconazole; Wound Infection

Owing to a lack of appropriate diagnostic and therapeutic approaches for mycotic keratitis, approximately one million cases of preventable corneal blindness are reported each year. The number of keratitis cases due to infection with Fusarium is increasing significantly worldwide, many of which are not treated adequately and in a timely manner due to frequent misdiagnosis. In the current report, we describe three cases of keratitis caused by Fusarium solani sensu stricto (FSSC5) from Turkey and The Netherlands, following ocular trauma. The etiological agent of keratitis, FSSC5, identified by sequencing of the partial tef1-α gene, exhibited low minimum inhibitory concentrations (MICs) of 1 µg/mL for amphotericin B and high MICs above the published epidemiological cutoff values for voriconazole (8 µg/mL). Patients were successfully treated with topical amphotericin B and voriconazole with complete recovery.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Eye Infections, Fungal; Eye Injuries; Female; Fungal Proteins; Fusariosis; Fusarium; Humans; Keratitis; Male; Microbial Sensitivity Tests; Middle Aged; Netherlands; Peptide Elongation Factor 1; Sequence Analysis, DNA; Treatment Outcome; Turkey; Voriconazole

New efficient antifungal agents are urgently needed to treat drug-resistant fungal infections. Here, we designed and synthesized a series of cationic xanthone amphiphilics as antifungal agents from natural α-mangostin to combat fungal resistance. The attachment of cationic residues on the xanthone scaffold of α-mangostin resulted in interesting antifungal agents with a novel mode of action. Two lead compounds (1 and 2) showed potent antifungal activity against a wide range of fungal pathogens, including drug-resistant Candida albicans, Aspergillus, and Fusarium strains and low cytotoxicity and hemolytic activity against mammalian cells. Both compounds can kill fungus rapidly by directly disrupting fungal cell membranes and avoid developing drug resistance. Additionally, compound 1 exhibited potent in vivo antifungal activity in the murine model of fungal keratitis. To our knowledge, membrane-targeting xanthone-based antifungals have not been reported previously. These results demonstrated that compounds 1 and 2 may be promising candidates for treating drug-resistant fungal infections.

Topics: Animals; Antifungal Agents; Aspergillus; Candida; Cell Line; Drug Evaluation, Preclinical; Drug Resistance, Fungal; Fibroblasts; Fusarium; Hemolytic Agents; Humans; Inhibitory Concentration 50; Keratitis; Mice, Inbred C57BL; Microbial Sensitivity Tests; Structure-Activity Relationship; Xanthones

This study aimed to assess the biofilm-forming ability of Candida spp. from the ocular conjunctiva of horses and to investigate the antifungal susceptibility of these biofilms.. Initially, the biofilm-forming ability of 15 strains was assessed by crystal violet staining, which reveals the fungal biomass adhered to the polystyrene plates, and scanning electron microscopy. Then, the minimum inhibitory concentrations (MICs) of amphotericin B, fluconazole, itraconazole, and caspofungin were initially determined against strains in planktonic form. Afterward, antifungal susceptibility of mature biofilms was evaluated by exposing them to 10 × MIC and 50 × MIC of the tested drugs, followed by the assessment of their metabolic activity, using the oxidoreduction indicator XTT. Results were analyzed through ANOVA and Tukey's post-test, and P-values below 5% led to significant conclusions.. Eight strains produced biofilms and were classified as strong (1/15), moderate (3/15) and weak (4/15) producers, according to the amount of crystal violet retained by the adhered fungal biomass. Biofilm metabolic activity of one C. tropicalis did not decrease after exposure to the tested antifungals, while biofilm metabolic activity of five strains was reduced by amphotericin B, but not the other drugs. One C. parapsilosis sensu stricto and one C. glabrata showed significant reduction in biofilm metabolic activity after exposure to fluconazole, itraconazole, and caspofungin, but not amphotericin B.. The results demonstrate that Candida from the ocular conjunctiva of horses can pose as a risk to animal health as they are capable of forming biofilms, which are commonly involved in fungal keratitis.

Topics: Amphotericin B; Animals; Antifungal Agents; Azoles; Biofilms; Candida; Caspofungin; Conjunctiva; Echinocandins; Eye Infections, Fungal; Fluconazole; Horse Diseases; Horses; Itraconazole; Keratitis; Lipopeptides; Microbial Sensitivity Tests

To determine the type of Candida species in ocular infections and to investigate the relationship of antifungal susceptibility profile to virulence factors.. Fifty isolates of yeast-like fungi from patients with keratitis, endophthalmitis, and orbital cellulitis were identified by Vitek-2 compact system and DNA sequencing of ITS1-5.8S-ITS2 regions of the rRNA gene, followed by phylogenetic analysis for phenotypic and genotypic identification, respectively. Minimum inhibitory concentration of six antifungal drugs was determined by E test/microbroth dilution methods. Phenotypic and genotypic methods were used to determine the virulence factors.. Phylogenetic analysis showed the clustering of all isolates into eight distinct groups with a major cluster formed Candida parapsilosis (n = 21), which was the most common species by both Vitek 2 and DNA sequencing. Using χ2 test no significant difference was noted between the techniques except that Vitek 2 did not identify C. viswanathii, C. orthopsilosis, and two non-Candida genera. Of 43 tested Candida isolates high susceptibility to amphotericin B (39/43, 90.6%) and natamycin (43/43, 100%) was noted. While none of the isolates produced coagulase, all produced esterase and catalase. The potential to form biofilm was detected in 23/43 (53.4%) isolates. Distribution of virulence factors by heat map analysis showed difference in metabolic activity of biofilm producers from nonbiofilm producers.. Identified by Vitek 2 and DNA sequencing methods C. parapsilosis was the most common species associated with eye infections. Irrespective of the virulence factors elaborated, the Candida isolates were susceptible to commonly used antifungal drugs such as amphotericin B and natamycin.

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Biofilms; Candida; Candidiasis; Child, Preschool; Endophthalmitis; Eye Infections, Fungal; Female; Humans; Keratitis; Male; Microbial Sensitivity Tests; Middle Aged; Natamycin; Orbital Cellulitis; RNA, Fungal; RNA, Ribosomal; Sequence Analysis, DNA; Virulence Factors; Young Adult

Fungal keratitis, a corneal fungal infection of the eye caused mainly by Candida species, has become the leading cause of blindness resulting from corneal disease in China. Present limitations in the management of ophthalmic fungal infections include the inability to provide long-term extraocular drug delivery without compromising intraocular structures and/or systemic drug exposure.. The aim of this study was to construct amphotericin B (AmB) loaded, chitosan-modified, nanostructured lipid carriers (AmB-CH-NLC) for prolonged ocular application and for the improvement of the targeted delivery of AmB to the ocular mucosa.. The AmB-CH-NLC was produced by the method of emulsion evaporation-solidification at low temperature. The particle size, zeta potential, and encapsulation efficiency, drug-release behavior, and corneal penetration ability were performed in vitro and in vivo.. The prepared AmB-CH-NLC nanoparticles exhibited a measured size of 185.4 nm, a zeta potential of 27.1 mV, and an entrapment efficiency of 90.9%. Sustained drug release behavior was observed in vitro. The in vivo ocular pharmacokinetic study indicated improved bioavailability of AmB-CH-NLC. The corneal penetration study showed that the AmB-CH-NLC could successfully penetrate into the cornea with no obvious irritation to the rabbits' eyes.. The results support that this novel nanomedicine could be a promising system for effective ocular delivery of amphotericin B for fungal keratitis-targeted therapy.

Topics: Administration, Ophthalmic; Amphotericin B; Animals; Antifungal Agents; Biological Availability; Chitosan; Delayed-Action Preparations; Drug Compounding; Emulsions; Eye Infections, Fungal; Keratitis; Lipids; Liposomes; Male; Nanoparticles; Particle Size; Permeability; Rabbits

In this study, we aimed to present the first molecular epidemiological data from Chennai, India, analyse keratitis cases that have been monitored in a university hospital during 2 years, identify the responsible Fusarium species and determine antifungal susceptibilities. A total of 10 cases of keratitis were included in the study. Fusarium isolates were identified using the second largest subunit of the RNA polymerase gene (RPB2) and the translation elongation factor 1 alpha (TEF1). Antifungal susceptibility was tested by the broth microdilution method according to the Clinical and Laboratory Standards Institute (CLSI) methodology. The aetiological agents belonged to Fusarium solani species complex (FSSC) (n = 9) and Fusarium sambucinum species complex (FSAMSC) (n = 1), and the identified species were Fusarium keratoplasticum (n = 7), Fusarium falciforme (n = 2) and Fusarium sporotrichioides (n = 1). All strains showed multidrug resistance to azoles and caspofungin but exhibited lower minimum inhibitory concentration (MIC) to natamycin and amphotericin B. Fusarium keratoplasticum and Fusarium falciforme belonging to the Fusarium solani species complex were the major aetiological agents of Fusarium keratitis in this study. Early presentation and 5% topical natamycin was associated with better patient outcome. Preventative measures and monitoring of local epidemiological data play an important role in clinical practice.

Topics: Administration, Topical; Adult; Amphotericin B; Antifungal Agents; Azoles; Caspofungin; Drug Resistance, Multiple, Fungal; Echinocandins; Female; Fusariosis; Fusarium; Genes, Fungal; Hospitals, University; Humans; India; Keratitis; Lipopeptides; Male; Microbial Sensitivity Tests; Middle Aged; Natamycin; Treatment Outcome

Phaeosphaeriaceae is a family in the order Pleosporales containing numerous plant pathogens, endophytes, lichenised fungi, and environmental saprobes. A novel genus, Tintelnotia is introduced containing two species, one of which caused an eye infection and several nail infections in humans. All species of Tintelnotia produce conidia in soft pycnidia with a wide ostiole. The generic type species is T. opuntiae causing necrotic spots on cactus plants. The isolates of the human opportunist T. destructans showed variable susceptibility pattern to a panel of common antifungal agents. The MICs of amphotericin B, voriconazole, posaconazole and itraconazole were 1 μg/mL, complemented by an in vitro MEC of 16 μg/mL against caspofungin; the MIC of terbinafine was 0.125 μg/mL. The latter compound contributed to the successful therapy in the ocular mycosis refractory to standard antifungal therapy, the benefit of terbinafine should be highlighted as a therapeutic option especially in difficult-to-treat fungal keratitis.

Topics: Amphotericin B; Antifungal Agents; Ascomycota; Caspofungin; Cornea; Echinocandins; Eye Infections, Fungal; Female; Humans; Itraconazole; Keratitis; Lipopeptides; Microbial Sensitivity Tests; Middle Aged; Nails; Naphthalenes; Phylogeny; Terbinafine; Triazoles; Voriconazole

We report a case of mycotic keratitis caused by Bipolaris oryzae with predisposing trauma from a foreign body. The fungus was identified by sequencing the internal transcribed spacer region, translation elongation factor 1α (TEF1) gene, and partial glyceraldehyde-3-phosphate dehydrogenase (GPDH) gene, and the species identity was confirmed on the basis of its characteristic conidial phenotype. The patient was treated with surgical intervention and antifungal agents, including intravenous fluconazole (FLC), oral itraconazole, topical 0.15% amphotericin B eye drops, and 0.5% FLC eye drops. To our knowledge, this is the first report of mycotic keratitis caused by B. oryzae worldwide.

Topics: Amphotericin B; Antifungal Agents; Ascomycota; Genes, Fungal; Humans; Keratitis; Male; Middle Aged; Ophthalmic Solutions; Opportunistic Infections; Phylogeny; Treatment Outcome

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Topics: Adolescent; Amphotericin B; Antifungal Agents; Cornea; Eye Infections, Fungal; Humans; Keratitis; Male; Ophthalmologic Surgical Procedures; Paecilomyces; Postoperative Complications

Fungal keratitis is a leading cause of ocular morbidity. It is frequently misdiagnosed as bacterial keratitis, causing a delay in proper treatment. Furthermore, due to the lack of safe and effective anti-fungal agents for clinical use, treatment of fugal keratitis remains a challenge. In recent years, antimicrobial peptides (AMPs) have received considerable attention as potent and broad-spectrum antimicrobial agents with the potential to overcome antibiotics resistance. We previously reported the design of short synthetic β-sheet forming peptides (IKIK)2-NH2 and (IRIK)2-NH2 with excellent antimicrobial activities and selectivities against various clinically relevant microorganisms, including Gram-positive Staphylococcus epidermidis and Staphylococcus aureus, Gram-negative Escherichia coli and Pseudomonas aeruginosa, and yeast Candida albicans (C. albicans). In this study, we evaluated the application of the two most promising synthetic β-sheet forming peptide candidates for in vivo fungal keratitis treatment in comparison with the commercially available amphotericin B. It was found that topical solutions of the designed peptides are safe, and as effective as the clinically used amphotericin B. Compared to the costly and unstable amphotericin B, (IKIK)2-NH2 and (IRIK)2-NH2 are water-soluble, less expensive and stable. Thus, the synthetic β-sheet forming peptides are presented as promising candidates for the treatment of fungal keratitis.

Topics: Amphotericin B; Animals; Anti-Bacterial Agents; Antimicrobial Cationic Peptides; Biofilms; Biomass; Candida albicans; Cell Survival; Contact Lenses; Drug Resistance, Bacterial; Escherichia coli; Humans; Keratitis; Mice; Mice, Inbred C57BL; Microbial Sensitivity Tests; Peptides; Protein Structure, Secondary; Pseudomonas aeruginosa; Staphylococcus aureus; Staphylococcus epidermidis

Cryptococcus albidus keratitis is a rare and difficult diagnosed disease. Here we report a case of C albidus keratitis early diagnosed by dot hybridization assay and successfully treated with intrastromal injection of Amphotericin B (AB).A 45-year-old man presented with left red eye for 2 days. The slit lamp examination exhibited deep corneal infiltrations. Smears and cultures were performed but revealed negative findings. Molecular detection of pathogens was performed by dot hybridization assay, and C albidus keratitis was diagnosed. Despite the identification of C albidus, the clinical condition still worsened due to deep corneal infiltration. After performing intrastromal injection of AB, the corneal infiltration gradually improved.C albidus is a rare cause of diseases in humans and should be considered as a potential pathogen of corneal ulcer. The prognosis of C albidus keratitis will improve if the condition is recognized early and treated properly.

Topics: Amphotericin B; Antifungal Agents; Cryptococcosis; Early Diagnosis; Humans; Keratitis; Male; Middle Aged

A retrospective case report on the management of a 56-year-old man who was diagnosed with Fusarium keratitis with an associated iris fungal nodule. He presented with persistent right ocular pain, redness, photophobia and reduced vision following an injury six weeks earlier. Conservative management with topical antibiotics and intracameral injections was successfully used to treat a rare case of Fusarium keratitis with an associated fungal iris nodule. The patient had complete resolution of his vision. Therefore, conservative management of the fungal nodule is a successful therapy without the risk of anterior chamber dissemination, which may occur with surgical resection.

Topics: Amphotericin B; Antifungal Agents; Drug Therapy, Combination; Fusariosis; Humans; Iris Diseases; Keratitis; Male; Middle Aged; Mycetoma; Voriconazole

To investigate the ocular toxicity and pharmacokinetics of intrastromal injection of amphotericin B (AmB) in a rabbit model.. Forty albino rabbits were randomly divided into five groups (eight per group). The rabbits were anesthetized before they received the medication. Intrastromal injection of 0.1 ml balanced salt solution containing 0, 5, 10, 20 or 30 μg of AmB was performed on eyes of each group five times (once per four days), respectively. The presence of possible corneal clouding, epithelial erosion and corneal neovascularization was monitored with a slit-lamp biomicroscope. Corneal ultrasonic pachymetry was used to detect the corneal thickness of intrastromal-injected eyes. Thirty days after the last injection, the corneal transparency as well as the number and ultrastucture of corneal endothelial cells were examined. The concentrations of the AmB in the cornea and aqueous humor were evaluated at 30 min, 6 h and at 1, 3 and 7 days after the intrastromal injection of 10 µg AmB.. Intrastromal injection of AmB at concentrations of 5 and 10 μg per 0.1 ml did not induce obvious toxicity to the cornea when compared with the controls. However, when the concentration of AmB increased to 20 μg per 0.1 ml or more, corneal edema, corneal epithelial erosion and severe neovascularization appeared. A single intrastromal injection of 10 μg AmB achieved an effective drug level in corneas which was maintained for up to 7 days.. Intrastromal injection of AmB at a concentration of less than 10 μg per 0.1 ml is safe to the rabbit corneas. Intrastromal injection of AmB may be an adjunctive treatment for deep recalcitrant fungal keratitis.

Topics: Amphotericin B; Animals; Anti-Bacterial Agents; Antifungal Agents; Aqueous Humor; Corneal Neovascularization; Corneal Stroma; Disease Models, Animal; Eye Infections, Fungal; Injections; Keratitis; Rabbits

The aim of this study was to review a series of consecutive cases of corneal and scleral infection by Paecilomyces spp. and to identify features of clinical presentation and assess treatment modalities.. This retrospective review of a case series included 22 patients with nontraumatic Paecilomyces anterior segment infections who were seen in a tertiary referral practice. Outcome measures were the number of eyes that were lost and visual acuity in eyes that were saved.. Twenty-two patients with Paecilomyces corneal or scleral infection with no significant history of trauma or surgery were identified over a 20-year period. Two distinct clinical presentations were noted with 17 presenting with corneal infection and 5 initially presenting with scleral infection, and all demonstrated a classical endothelial plaque and deep stromal infiltrate. Almost all required single or multiple anterior segment reconstructive surgeries together with systemic and topical antifungal agents. The first 10 patients were treated with amphotericin B, whereas the remaining 12 patients were treated with voriconazole and 21 of 22 patients underwent surgery. Paecilomyces spp. was identified from most intraocular specimens although corneal fungal growth was noted only from deep corneal biopsies or corneal buttons removed during corneal transplantation. Outcomes were better in the last 12 patients treated with voriconazole.. Nontraumatic Paecilomyces anterior segment infection presents with a pathognomonic clinical picture when the cornea is the initial site of infection and later in scleral infections. Early identification and aggressive treatment with extirpative surgery and voriconazole may result in retention of the eye with useful vision.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Eye Infections, Fungal; Female; Humans; Keratitis; Male; Middle Aged; Mycoses; Paecilomyces; Retrospective Studies; Scleritis; Voriconazole; Young Adult

Fusarium species are among the most common fungi present in the environment and some species have emerged as major opportunistic fungal infection in human. However, in immunocompromised hosts they can be virulent pathogens and can cause death. The pathogenesis of this infection relies on three factors: colonization, tissue damage, and immunosuppression. A novel Fusarium species is reported for the first time from keratitis in an agriculture worker who acquired the infection from plant material of maize. Maize plants are the natural host of this fungus where it causes stalk rot and seeding malformation under temperate and humid climatic conditions. The clinical manifestation, microbiological morphology, physiological features and molecular data are described.. Diagnosis was established by using polymerase chain reaction of fungal DNA followed by sequencing portions of translation elongation factor 1 alpha (TEF1 α) and beta-tubulin (BT2) genes. Susceptibility profiles of this fungus were evaluated using CLSI broth microdilution method.. The analyses of these two genes sequences support a novel opportunist with the designation Fusarium temperatum. Phylogenetic analyses showed that the reported clinical isolate was nested within the Fusarium fujikuroi species complex. Antifungal susceptibility testing demonstrated that the fungus had low MICs of micafungin (0.031 μg/ml), posaconazole (0.25 μg/ml) and amphotericin B (0.5 μg/ml).. The present case extends the significance of the genus Fusarium as agents of keratitis and underscores the utility of molecular verification of these emerging fungi in the human host.

Topics: Amphotericin B; Antifungal Agents; Base Sequence; DNA, Fungal; Echinocandins; Fungal Proteins; Fusarium; Humans; Keratitis; Lipopeptides; Micafungin; Microbial Sensitivity Tests; Molecular Sequence Data; Multilocus Sequence Typing; Mycoses; Phylogeny; Sequence Analysis, DNA; Treatment Outcome; Triazoles; Tubulin; Zea mays

We report a case of mycotic keratitis caused by a rare fungus Schizophyllum commune.. Clinical examination, slit-lamp examination, and microbiological evaluation of the corneal ulcer were done, and its treatment outcome was studied. The fungal etiology was established by conventional microbiological techniques, polymerase chain reaction and speciation by DNA sequencing.. Corneal scraping showed the presence of fungal filaments. The fungus was identified as S. commune based on DNA sequence analysis of the internal transcribed spacer region. The organism was susceptible to amphotericin B and voriconazole and demonstrated resistance to anidulafungin, itraconazole, and fluconazole. Therapeutic keratoplasty was performed but there was recurrence of the infection in the graft, which was controlled with topical voriconazole and intracameral amphotericin B. At the end of 3 months, the affected eye had developed phthisis bulbi.. The best of our knowledge, this is the first reported case of keratitis caused by the rare fungus S. commune. Management of these cases is difficult, and surgical procedures may be needed.

Topics: Administration, Topical; Adult; Amphotericin B; Antifungal Agents; Cornea; Corneal Transplantation; DNA, Fungal; DNA, Ribosomal Spacer; Humans; Keratitis; Male; Molecular Sequence Data; Mycoses; Polymerase Chain Reaction; Pyrimidines; Schizophyllum; Sequence Analysis, DNA; Treatment Outcome; Triazoles; Voriconazole

To evaluate the disinfectant effect of methylene blue (MB)-mediated photodynamic therapy (PDT) on a pathogenic strain of Acanthamoeba.. Acanthamoeba castellanii (ATCC 50370) used in this study were treated under one of four experimental conditions: light irradiation and incubation in MB (L+M+), light irradiation and incubation in physiologic solution (L+M-), incubation in MB only (L-M+), and incubation in physiologic solution (L-M-). M+ trophozoites were incubated in either 0.25 or 0.5 mM MB for 10 minutes. L+ organisms were irradiated for 30 minutes following incubation in solution. A halogen lamp (660 ± 10 nm) with a maximum output of 6 mW/cm(2) was used as the PDT light source. After treatment, antiacanthamoeba activity was evaluated by checking the respiratory activity of the amoeba with 5-cyano-2,3-tetrazolium chloride (CTC) staining. We also determined whether the effect of PDT with MB had been retained or augmented when it was performed in combination with conventional antiamoebic agents.. MB-PDT suppressed the respiratory activity of trophozoites in an MB-concentration-dependent manner at total light doses of 10.8 J/cm(2). The respiratory activity of each group as a percentage of that of L-M- is as follows: L+M+ 11.6% (0.5 mM), 60.9% (0.25 mM); L-M+ 116.5% (0.5 mM), 105.5% (0.25 mM); L+M- 107.6%; and L-M- 106.3%. (L+M+ versus L-M- P < 0.05). MB-PDT had a synergistic effect when used in combination with polyhexamethylene biguanide (PHMB) or amphotericin B, but not with voriconazole.. MB-PDT is effective against Acanthamoeba in vitro and has synergistic effects with PHMB and amphotericin B.

Topics: Acanthamoeba castellanii; Amebiasis; Amebicides; Amphotericin B; Animals; Antifungal Agents; Drug Therapy, Combination; Enzyme Inhibitors; Guanidines; Humans; In Vitro Techniques; Keratitis; Methylene Blue; Mice; Mice, Inbred C57BL; Photochemotherapy; Photosensitizing Agents; Polymers; Pyrimidines; Riboflavin; Triazoles; Ultraviolet Therapy; Voriconazole

Pseudodendritic keratitis in a contact lens wearer is generally associated with acanthamoeba keratitis. We report a case of isolated pseudodendritic fungal epithelial keratitis that occurred in an extended wear contact lens user.. A 48-year-old woman was evaluated in our clinic for a 36-hour history of left eye pain. She wore extended wear soft contact lenses and frequently rinsed her eyes with tap water. Her left cornea had a paracentral 3-mm area of epithelium with raised ridges in a pseudodendritic pattern. The underlying corneal stroma was normal. A therapeutic and diagnostic corneal scraping of the lesion was performed and sent for Gomori methenamine silver (GMS) staining. The clinical concern was for epithelial acanthamoeba keratitis.. The GMS staining revealed septate fungal hyphae within sheets of corneal epithelium. The patient was started on frequent alternating natamycin (5%) and amphotericin B (0.15%) antifungal eyedrops and exhibited a rapid clinical response. Her keratitis completely resolved, and her vision returned to her baseline of 20/25. Corneal fungal cultures showed no growth.. Our case is an extremely unusual presentation of fungal keratitis, which rarely presents as a pseudodendritic epithelial keratitis. There are two previous similar case reports initially misdiagnosed as acanthamoeba keratitis. Clinicians should be aware that isolated fungal epithelial keratitis can present as a distinct entity and should be considered in the differential diagnosis of pseudodendritic keratitis. The GMS staining is an excellent diagnostic test in a patient presenting with pseudodendritic keratitis because it allows rapid diagnosis of acanthamoeba and fungal infections.

Topics: Amphotericin B; Antifungal Agents; Contact Lenses, Extended-Wear; Diagnosis, Differential; Drug Administration Schedule; Eye Infections, Fungal; Female; Humans; Keratitis; Keratitis, Dendritic; Middle Aged; Natamycin; Ophthalmic Solutions; Recovery of Function; Staining and Labeling; Vision Disorders

Topics: Amphotericin B; Antifungal Agents; Aspergillus; Drug Synergism; Eye Infections, Fungal; Fusarium; Humans; India; Keratitis; Natamycin

This is a case study of Fusarium keratitis progressing to endophthatmitis that was successfully treated with a tiposomal formulation of amphotericin B (AmBisome] and local natamycin 5%.. A 41-year-old man presented with a clinical picture of endophthalmitis following deep Fusarium solani keratitis. Treatment with natamycin 5% drops and intravenous amphotericin B 150 mg per day caused renal failure and did not alleviate the endophthalmitis. Therefore, intravenous amphotericin B was replaced with intravenous AmBisome, 300 mg per day, to a cumulative dosage of 5.4 g.. Both the endophthalmitis and keratitis were alleviated within several weeks after starting AmBisome treatment. No systemic toxicity was noted. The final ophthalmoLogic examination showed a paracentral corneal scar, and a satisfactory best corrected visual acuity of 20/40.. Due to their relatively low systemic toxicity, liposomal formulations of amphotericin B can be administered in higher doses than traditional unencapsulated ntravenous amphotericin B achieving higher concentrations in the target organ.

Topics: Acute Kidney Injury; Adult; Amphotericin B; Antifungal Agents; Endophthalmitis; Fusarium; Humans; Injections, Intravenous; Keratitis; Male; Mycoses; Natamycin; Visual Acuity

To describe changes in demographics and pathogens for fungal keratitis cases diagnosed at the Massachusetts Eye and Ear Infirmary.. Patient demographics, clinical and laboratory findings, treatment and outcomes of 46 cases of culture-proven fungal keratitis diagnosed from January 2004 through November 2007 were compared with 23 cases of fungal keratitis previously collected over a similar period from January 1999 through November 2002.. During 2004-2007, the rate of fungal keratitis was 1.0 cases per month, an increase from the baseline rate of 0.5 cases per month during 1999-2002. The proportion of cases caused by filamentous fungi increased from 30% (1999-2002) to 65% (2004-2007) (P = 0.01). Soft contact lens wear accounted for 41% of fungal keratitis cases in 2004-2007, as compared with 17% in 1999-2002. The majority of patients (70%) received oral antifungal treatment in addition to topical amphotericin B and natamycin. Seventeen patients (40%) required therapeutic keratoplasty. Patients with a history of corneal transplant had the highest rate of therapeutic keratoplasties (67%) and had the poorest visual outcome (40% counting fingers or less). In the contact lens group, 94% of patients maintained vision of at least 20/40 and only 12% required surgery to control the infection.. There has been an increase in fungal keratitis in the Boston area and a change in the causative pathogens and risk factors for infection. Filamentous fungi now account for the majority of fungal keratitis cases, whereas yeasts were the predominant pathogen in the past. Soft contact lens wear is currently the most common risk factor for development of fungal keratitis.

Topics: Administration, Oral; Administration, Topical; Adult; Aged; Alternaria; Amphotericin B; Antifungal Agents; Boston; Candidiasis; Cohort Studies; Contact Lenses; Corneal Transplantation; Drug Therapy, Combination; Eye Infections, Fungal; Female; Fusarium; Humans; Incidence; Keratitis; Male; Middle Aged; Natamycin; Retrospective Studies; Risk Factors; Treatment Outcome

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

The prognosis for Fusarium keratitis is poor. Effective drugs to treat this infection are therefore needed.. A patient presented Fusarium solani keratitis. The infection regressed with topical amphotericin B and intravenous voriconazole. Topical steroids were introduced. There was reactivation and extension of the infection, invading the anterior chamber. Steroids were discontinued and the antifungal treatment was restarted but there was continued deterioration. Recovery was achieved without surgery, with topical voriconazole, topical liposomal amphotericin B, topical natamycin, intravenous liposomal amphotericin B, and intravenous voriconazole.. Combined orally and topically administered voriconazole is a promising therapy when the minimum inhibitory concentration is approximately 2 microg/ml. Liposomal amphotericin B seems to be the most effective drug for the different infection stages. Posaconazole is a useful alternative but further investigations must be pursued.

Topics: Amphotericin B; Antifungal Agents; Drug Resistance, Fungal; Eye Infections, Fungal; Fusarium; Humans; Keratitis; Liposomes; Male; Middle Aged; Mycoses; Remission Induction

To describe the current practice patterns and prescription preferences in treating microbial keratitis in Thailand.. A questionnaire was designed and sent to ophthalmologists to describe their practice in patients with microbial keratitis. The questionnaire also presented two case scenarios with microbial keratitis; the less severe in the first patient and the more severe in the second. The recipients were asked about their diagnostic and therapeutic approaches. The surveys were mailed to 300 ophthalmologists around the country.. One hundred and forty-three surveys (48.6%) were used in the analysis. Over half the respondents (56%) would do corneal scraping for some patients with suspected microbial keratitis. Smears and cultures of corneal specimens are the most common diagnostic tools (92%) to identify the causative organisms. Of the respondents, 60% would treat Case 1 as an outpatient, compared with 90% would admit Case 2. About half the respondents (47%) would initiate treatment in Case 1 without obtaining scrapings, whereas 79% would prefer microbial work up in Case 2. Monotherapy with topical fluoroquinolone was the most common initial antibiotic prescribed for Case 1 (36%), whereas in Case 2, combined fortified antibiotics (23%) and combined topical antibiotic and topical antifungal (22%) were preferred. For fungal keratitis, topical natamycin and amphotericin B were the most common choices (20% each).. Most Thai ophthalmologists appear to treat patients with suspected microbial keratitis differently, depending on etiology and severity. However, there are some variations in management. The validity of this approach should be established to specify patterns that are most safe and effective.

Topics: Adolescent; Adult; Aminoglycosides; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Cefazolin; Data Collection; Female; Fluoroquinolones; Humans; Keratitis; Male; Middle Aged; Natamycin; Practice Patterns, Physicians'; Surveys and Questionnaires; Thailand

A 54-yr-old male, who was treated by chemotherapy for gastric cancer 15 months ago, presented to Yongdong Severance Hospital, Seoul, with complaints of pain in his right eye caused by a foreign body from the ground in the previous week. He had been treated with topical and oral antibacterial in addition to antifungal agents, but did not show significant clinical improvement. After a positive corneal culture with mold, topical amphotericin B was added to the initial regimen. The mold was identified as Scedosporium apiospermum by macroscopic and microscopic morphologies and the nucleotide sequences of a fungal PCR product showing 99% homology with those of S. apiospermum (EF151349). He recovered with good results at 25 days after corneal epithelial debridement. The early diagnosis of S. apiospermum keratitis is very important for proper treatment. It is recommended that molecular diagnostic methods such as fungal PCR and sequencing be done with conventional cultures whenever a fungal infection is suspected.

Topics: Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Cornea; Drug Therapy, Combination; Eye Infections, Fungal; Humans; Keratitis; Male; Middle Aged; Polymerase Chain Reaction; Scedosporium; Sequence Analysis, DNA

To report the clinical, histopathologic, microbiologic, and confocal microscopic features of Candida keratitis after deep anterior lamellar keratoplasty (DALK).. We performed clinical, confocal scan, microbiologic and histopathologic examinations on two corneas from 2 young patients who underwent DALK for keratoconus.. The first patient presented with asymptomatic white to cream-colored interface deposits 2 months after DALK. The confocal scan disclosed clusters of hyperreflective, fine granular deposits at the region of interface, with no evidence of inflammation or hyphaelike structures. The clinical presumption of possible "epithelial downgrowth" was suggested, and because of the progression of these lesions, irrigation of the interface was considered. Finally, penetrating keratoplasty was performed because of a rupture in the Descemet membrane. Histopathologic examination of the cornea disclosed yeastlike structures within the interface area. The microbiologic results of the irrigation fluid showed Candida glabrata. The second patient presented with a symptomatic infiltration of the inferior interface close to the suture site 2.5 months after DALK. The confocal scan showed foci of inflammation with clusters of hyperreflective round-shaped structures that resembled epithelial cells. Clinically, there was a suggestion of epithelial downgrowth, and subsequently, penetrating keratoplasty was performed because of the progression of the lesion. Histopathologic examination of the cornea disclosed an acute and chronic granulomatous keratitis caused by yeastlike structures. The microbiologic results revealed infection with Candida albicans.. These are the first reported occurrences of interface Candida keratitis after DALK and with different confocal features. The clinical and the confocal features of interface Candida keratitis may be similar to those seen in epithelial downgrowth, which may postpone correct diagnosis and treatment. Candida keratitis should be considered in cases of interface deposits after any form of lamellar keratoplasty.

Topics: Adult; Amphotericin B; Antifungal Agents; Candida albicans; Candida glabrata; Candidiasis; Cornea; Corneal Transplantation; Drug Therapy, Combination; Eye Infections, Fungal; Humans; Keratitis; Keratoconus; Keratoplasty, Penetrating; Ketoconazole; Male; Microscopy, Confocal; Natamycin; Postoperative Complications

The authors report an unusual case of fungal keratitis caused by Histoplasma capsulatum in a male immunocompetent patient. PCR confirmed the presence of the fungus DNA in the material studied. To our knowledge this is the first reported case in humans described all over the world.

Topics: Adult; Amphotericin B; Antifungal Agents; Aza Compounds; Eye Infections, Fungal; Fluoroquinolones; Histoplasma; Humans; Keratitis; Male; Moxifloxacin; Quinolines

Fungal keratitis is a rare but serious condition that may result in loss of vision. The potentially poor prognosis might be due to a delay in diagnosis and/or to limited treatment options. The aim of this study is to evaluate the clinical outcome of patients treated with topical fluconazole 0.2% for the treatment of filamentous fungal keratitis.. Retrospective case series. A chart review of all patients evaluated at the Ophthalmology Department of the Hospital de Clínicas in Paraguay from January 1997 to December 2000 identified 25 cases of fungal keratitis. Among these cases, one patient discontinued the treatment and another received amphotericin as the first line drug, resulting in 23 cases available for data analysis. Twelve patients were treated with topical fluconazole 0.2% alone (Group I) and 11 patients received a combination of topical fluconazole 0.2% and oral ketoconazole 200 mg twice daily (Group II).. Sixteen of 23 cases showed resolution of the keratitis, 9/12 (75%) in Group I and 7/11 (64%) in Group II. Seven patients (30%) did not respond to medical treatment and required a surgical procedure to preserve eye integrity. Superficial and small ulcers have a significantly better prognosis than do lrge and deep ulcers. Concomitant oral ketoconazole (400 mg/day) did not improve the clinical results.. Our findings of study suggest that topical fluconazole 0.2% is a safe and effective antifungal drug for the management of filamentous mycotic keratitis, particularly in cases that are not severe. The addition of oral ketoconazole to topical fluconazole did not improve the clinical outcome.

Topics: Administration, Topical; Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Child; Drug Therapy, Combination; Eye Infections, Fungal; Female; Fluconazole; Fungi; Humans; Keratitis; Ketoconazole; Male; Middle Aged; Ophthalmic Solutions; Retrospective Studies; Treatment Outcome

A 52-year-old man had laser in situ keratomileusis in March 2002 and 2 weeks later had a corneal infection that was found to be caused by Exophiala dermatitidis. This infection waxed and waned for 9 months despite therapy with natamycin, itraconazole, and fluconazole but eventually responded to topical amphotericin. He recovered good visual acuity in this eye with a rigid gas-permeable lens. This case shows the importance of selecting the appropriate agent in fungal keratitis.

Topics: Amphotericin B; Antifungal Agents; Exophiala; Eye Infections, Fungal; Humans; Keratitis; Keratomileusis, Laser In Situ; Male; Microbial Sensitivity Tests; Middle Aged; Mycoses; Myopia; Postoperative Complications; Recurrence

To standardize in-vitro antifungal susceptibility testing by agar dilution method to find out the minimum inhibitory concentration (MIC) of amphotericin B, fluconazole and ketoconazole on ocular fungal isolates.. A total of 180 ocular fungal isolates (130 filamentous fungi and 50 yeasts) were included. The antifungal drugs such as amphotericin B (0.0625-8 microg/mL), fluconazole (0.2-819.6 microg/mL) and ketoconazole (0.025-6.4 microg/mL) were incorporated in doubling dilutions in the yeast nitrogen base medium. The MIC was determined as the lowest concentration of the antifungal drug preventing growth of macroscopically visible colonies on drug containing plates when there was visible growth on the drug-free control plates.. All 50 ocular isolates of yeast were susceptible to amphotericin B, while two (4%) and five (10%) strains were resistant to fluconazole and ketoconazole respectively. Of the 130 filamentous fungi tested, six (4.6%) were resistant to amphotericin B, 49 (37.7%) and 10 (7.6%) were resistant to fluconazole and ketoconazole respectively. Percentile 50 (MIC 50) and Percentile 90 (MIC 90) for all the three antifungal agents were calculated. Aspergillus niger, Aspergillus terreus and Candida krusei were found to be resistant to fluconazole and ketoconazole.. This technique was found to be reliable, cost effective and easy to perform with consistent results.

Topics: Amphotericin B; Antifungal Agents; Aspergillus; Candida; Drug Resistance, Fungal; Eye Diseases; Fluconazole; Keratitis; Ketoconazole; Microbial Sensitivity Tests; Mitosporic Fungi; Mycoses

Fungal keratitis is one of the most difficult corneal infections to be properly diagnosed and treated.. Diagnostic and therapeutic approaches in atypical keratitis, regarding a case.. The paper presents a case of stromal fungal keratitis successfully treated with topical amphotericin B 0,2% and natamycin 5%. The clinical appearance and the indolent course directed the diagnosis, the micro-biological analysis of corneal scrapings being negative. Further on, there are presented the laboratory investigations and the available antifungal agents, because proper therapy early in the course of the disease can be crucial to a successful outcome.. Clinical suspicion of fungal keratitis is essential to diagnosis, but once the diagnosis is made, the treatment remains difficult. Direct microscopic examination of corneal tissues using specific stains is a very useful and inexpensive method of diagnosis, being conclusive in 80% of cases.

Topics: Adult; Amphotericin B; Antifungal Agents; Drug Therapy, Combination; Eye Infections, Fungal; Female; Humans; Keratitis; Microscopy, Acoustic; Natamycin; Ophthalmic Solutions; Treatment Outcome

To evaluate the efficacy of using phototherapeutic keratectomy (PTK) in the treatment of superficial keratomycosis.. We studied 9 patients with superficial keratomycosis that had infiltrated less than half of the corneal thickness and responded poorly to topical antifungal therapy. Using a 193-nm excimer laser, we performed PTK to try to eradicate the infiltrates and facilitate antifungal therapy. We compared our study group findings with those of a control group made up of 31 cases of keratomycosis, also involving infiltration of less than half of the corneal thickness that had been treated with traditional surgical procedures and topical antifungal agents.. Using PTK and short-term antifungal eyedrops, we were able to eradicate keratomycosis without recurrence in all 9 study patients. Much less time was needed to treat the PTK group (12.9 +/- 3.6 days) than the control group (40.8 +/- 26.4 days) (P <0.05). After PTK, the ablated area underwent rapid reepithelialization (average, 3.6 +/- 1.8 days). Final vision ranged from 20/200 to 20/20. The PTK group had an average visual improvement of 2.9 +/- 2.1 lines, which was significantly better than final improvement found in the control group (average, 0.6 +/- 1.7 lines) (P < 0.05). PTK complications included mild corneal haze, astigmatism, and thinning cornea.. Because PTK can shorten treatment time, hasten reepithelialization, and restore reasonably good vision, it can be a valuable therapeutic alternative for superficial keratomycosis, especially in instances in which there is poor response to treatment by topical antifungal agents alone.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus; Child; Cornea; Drug Therapy, Combination; Eye Infections, Fungal; Female; Fluconazole; Follow-Up Studies; Humans; Keratitis; Lasers, Excimer; Male; Middle Aged; Ophthalmic Solutions; Photorefractive Keratectomy; Retrospective Studies; Secondary Prevention; Treatment Outcome; Visual Acuity; Wound Healing

Candida albicans is the most frequent cause of fungal keratitis in temperate regions. Caspofungin has potent activity against Candida spp. in a variety of clinical settings. Little is known, however, about its activity against fungal keratitis. We compared the efficacy of topical caspofungin with that of topical amphotericin B (AMB) in a rabbit model of experimental keratomycosis. Keratitis was induced with a standardized inoculum of Candida albicans (SC 5314) placed on the debrided cornea. Twenty-four hours after infection, animals were randomly assigned to treatment with 0.15% caspofungin, 0.5% caspofungin, 0.15% AMB, and a saline control (n = 12 rabbits in each group). For the first 12 h, treatment was repeated every 30 min and, after a 12-h pause, was resumed at hourly intervals for another 12 h. The animals were examined and killed 12 h after administration of the last dose. Treatment effects were evaluated by clinical assessment, fungal culture, and histopathology. Drug treatment significantly reduced corneal fungal recovery from 3.78 log10 CFU in saline-treated animals to 2.97, 1.76, and 1.18 log10 CFU in animals treated with 0.15% caspofungin, 0.5% caspofungin, and 0.15% AMB, respectively. By histopathology, the mean hyphal density was significantly lower in the corneas of treated animals than in those of the controls; there was no difference in hyphal densities between the different treatment groups. The depth of corneal invasion was not significantly reduced by the antifungal treatments. By clinical assessment, keratitis progressed in animals treated with saline, whereas disease progression was inhibited by all drug treatment regimens. In our rabbit model, 0.5% caspofungin was as effective as 0.15% AMB for the topical treatment of Candida keratitis. The potential clinical efficacy of caspofungin awaits further investigation.

Topics: Administration, Topical; Amphotericin B; Animals; Antifungal Agents; Candida albicans; Candidiasis; Caspofungin; Disease Models, Animal; Echinocandins; Eye Infections, Fungal; Humans; Keratitis; Lipopeptides; Male; Peptides, Cyclic; Rabbits; Treatment Outcome

A case of invasive Fusarium keratitis in a previously healthy male patient was treated successfully with cornea transplantation and systemic and topical voriconazole after treatment failure with topical amphotericin B and systemic itraconazole. Topical voriconazole was well tolerated, and, in conjunction with the oral administration, it resulted in a high level of the drug in the anterior chamber of the eye (which was 160% of the plasma drug level).

Topics: Adult; Amphotericin B; Antifungal Agents; Cornea; Corneal Transplantation; Fusarium; Humans; Itraconazole; Keratitis; Male; Mycoses; Pyrimidines; Triazoles; Voriconazole

Scedosporium prolificans is an unusual infection, especially following pterygium surgery. A 63-year-old man who developed an uncomfortable, red right eye 10 years after pterygium surgery with adjunctive mitomycin C is described. To the best of the authors' knowledge, this is the first reported case of S. prolificans sclerokeratitis following pterygium surgery with adjunctive mitomycin C.

Topics: Amphotericin B; Antibiotics, Antineoplastic; Antifungal Agents; Chemotherapy, Adjuvant; Drug Therapy, Combination; Eye Infections, Fungal; Humans; Keratitis; Male; Middle Aged; Mitomycin; Mycetoma; Naphthalenes; Postoperative Complications; Pterygium; Pyrimidines; Scedosporium; Scleritis; Terbinafine; Triazoles; Voriconazole

To describe a case of keratomycosis caused by Arthrographis kalrae, mimicking Acanthamoeba keratitis.. Case report.. A 23-year-old female contact lens wearer developed dendritic keratitis in her amblyopic eye (OD). Baseline vision was 20/50. Treatment with trifluridine 1% resulted in resolution of the dendrite, but an area of stromal haze developed, spreading to a discontinuous ring shape, and the vision dropped to 20/200. Photophobia was intense, and pain was out of proportion to the examination. Cultures were sent, and empiric treatment of Acanthamoeba was begun, without subsequent improvement. After 4 weeks, cultures were positive for a fungal species. Amphotericin 0.5% drops were begun, with moderately rapid resolution of the active keratitis. At last follow-up, best-corrected vision was 20/100. Review of the culture showed the organism to be Arthrographis kalrae.. Arthrographis kalrae has been reported only once before as an ocular pathogen. As in the previously reported case of Arthrographis, our patient's presentation was strongly suggestive of Acanthamoeba keratitis.

Topics: Acanthamoeba Keratitis; Adult; Amphotericin B; Antifungal Agents; Diagnosis, Differential; Eye Infections, Fungal; Female; Humans; Keratitis; Keratitis, Dendritic; Mitosporic Fungi; Mycoses; Ophthalmic Solutions

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Cornea; Corneal Injuries; Eye Infections, Fungal; Foreign Bodies; Humans; Keratitis; Male; Metals; Middle Aged

To present a case of Candida parapsilosis following laser in situ keratomileusis (LASIK).. Retrospective chart review.. A case report of a 51-year-old woman who underwent bilateral LASIK is presented. Two weeks after the procedure, the patient presented with epithelial ingrowth OD. The ingrowth was treated with flap lifting and scraping, followed by postoperative antibiotics. Four weeks later, the patient presented with numerous interface infiltrates. Smears were positive for yeast forms and cultures grew Candida parapsilosis. Administration of topical and systemic antifungal therapy resulted in clearing of the infection with partial visual recovery.. To our knowledge, this represents the first reported case of a post-LASIK Candida parapsilosis keratitis. A high degree of suspicion coupled with rapid and appropriate treatment can result in visual recovery.

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Debridement; Drug Therapy, Combination; Epithelium, Corneal; Eye Infections, Fungal; Female; Fluconazole; Humans; Keratitis; Keratomileusis, Laser In Situ; Middle Aged; Ofloxacin; Postoperative Complications; Retrospective Studies; Surgical Flaps

Topics: Amphotericin B; Antifungal Agents; Cornea; Eye Infections, Fungal; Female; Humans; Keratitis; Keratoplasty, Penetrating; Middle Aged; Mycoses; Rhodotorula; Surgical Wound Infection

Mycotic keratitis usually occurs in conjunction with trauma to the cornea. Scedosporium apiospermum, a dematiaceous fungus linked to the teleomorph Pseudallescheria boydii is not a common agent of mycotic keratitis. A 22-year old male patient with mycotic keratitis due to S. apiospermum is presented. In in vitro susceptibility testing, the isolate showed resistance against amphotericin B (minimum inhibitory concentration [MIC] 16 microg ml(-1)) but was susceptible to itraconazole (ITC) and fluconazole with MICs of 0.125 microg ml(-1) and 4 microg ml(-1), respectively. The patient was cured clinically after ITC treatment and surgical intervention. Azoles may be superior for eliminating S. apiospermum from infected ocular sites.

Topics: Adult; Amphotericin B; Antifungal Agents; Drug Resistance, Fungal; Eye Infections, Fungal; Fluconazole; Humans; Itraconazole; Keratitis; Male; Microbial Sensitivity Tests; Mycetoma; Scedosporium; Treatment Outcome

We report a case of Candida infection after laser in situ keratomileusis (LASIK) and review the literature for reports of post-LASIK fungal infections. Risk factors may include postoperative surgical intervention and extended use of topical steroids.

Topics: Amphotericin B; Antifungal Agents; Candida; Candidiasis; Cornea; Drug Therapy, Combination; Eye Infections, Fungal; Flucytosine; Humans; Keratitis; Keratomileusis, Laser In Situ; Male; Microscopy, Confocal; Middle Aged

Topics: Acremonium; Aged; Amphotericin B; Antifungal Agents; Cornea; Delftia acidovorans; Eye Infections; Eye Infections, Bacterial; Eye Infections, Fungal; Female; Gram-Negative Bacterial Infections; Humans; Keratitis; Male; Microsporum; Middle Aged; Mycoses; Natamycin; Ophthalmic Solutions

To evaluate Colletotrichum keratitis and to report the risk factors and clinical course.. Interventional case series.. In order to report the clinical course of Colletotichum keratitis, fungal keratitis cases between January 1980 and February 2001 in an institutional setting were retrospectively reviewed and 10 eyes of 9 patients with Colletotrichum keratitis were identified by positive cultures.. Colletotrichum species were identified in 10 of 360 culture-proven fungal keratitis cases. All cases were sensitive to amphotericin B, three of the isolates showed resistance to natamycin, two isolates had intermediate sensitivity to natamycin, and one isolate was resistant to fluconazole. Natamycin 5% was used as the initial antifungal agent in eight microbiologically proven fungal keratitis cases. Two of nine patients continued the treatment with amphotericin B 0.15% after the sensitivity results were obtained.. Colletotrichum is an infrequent cause of fungal keratitis. The risk factors are similar to the known fungal keratitis. Colletotrichum is resistant to natamycin in vitro; however, all our patients responded well to this treatment while resistance or intermediate sensitivity to natamycin and resistance to fluconazole was observed.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Colletotrichum; Cornea; Drug Resistance, Microbial; Eye Infections, Fungal; Female; Humans; Keratitis; Male; Microbial Sensitivity Tests; Mycoses; Natamycin; Ophthalmic Solutions; Retrospective Studies

We report a case of penicillium keratitis in vernal shield ulcer in the absence of corticosteroid use. This report illustrates super-added infection in vernal shield ulcer by an organism which is otherwise innocuous and forms a part of the normal ocular flora.

Topics: Amphotericin B; Child; Conjunctivitis, Allergic; Drug Therapy, Combination; Eye Infections, Fungal; Humans; Keratitis; Male; Mycoses; Natamycin; Penicillium; Risk Factors; Treatment Outcome

To describe a patient with Exophiala jeanselmei keratitis. METHODS.. One patient with persistent corneal infiltrate that developed several days after a minor ocular trauma from an onion slice.. Culture plates from corneal scraping showed a growth of the yeast Exophiala jeanselmei, a rare causative agent of ocular infection.. Whenever a corneal abscess does not improve with the usual antibiotic treatment, a thorough ophthalmic history should be taken to determine whether there was a recent ocular trauma. If the trauma was caused by a plant material, the physician should raise the possibility of an unusual fungal infection.

Topics: Amphotericin B; Anti-Infective Agents, Local; Chlorhexidine; Corneal Injuries; Drug Therapy, Combination; Exophiala; Eye Infections, Fungal; Eye Injuries; Female; Humans; Keratitis; Middle Aged; Mycoses; Natamycin; Wounds, Nonpenetrating

To report a case of fungal keratitis caused by Verticillium species.. A 50-year-old man developed pain, redness, and an infiltrate in his left eye and had no history of trauma. The cornea showed superficial, white, stromal infiltrates and epithelial ulceration with a dendritic margin. The clinical features suggested herpetic keratitis, and the patient was treated with topical antiviral medication. Two weeks later, his condition deteriorated. Examination of the left eye showed stromal infiltrates with a feathery margin and epithelial ulceration with its covering white exudates. Corneal scrapings were taken for direct microscopic examination and culture.. Corneal scraping showed the presence of fungal filaments. The fungus was identified as Verticillium species. Topical amphotericin B and systemic fluconazole were started after discontinuing the antiviral treatment. Clinically, the inflammation subsided during the 3 weeks after treatment.. This is a rare case of infectious keratitis caused by Verticillium species. Rare species of fungal infection should be considered in the differential diagnosis of stromal keratitis refractive to conventional medical treatment.

Topics: Amphotericin B; Antifungal Agents; Drug Therapy, Combination; Eye Infections, Fungal; Fluconazole; Humans; Keratitis; Male; Middle Aged; Mycoses; Verticillium

We report a case of mixed Aspergillus fumigatus and coagulase-negative Staphylococcus stromal keratitis in a 43-year-old man who developed discomfort and swelling in his right eye 20 days after uneventful bilateral laser in situ keratomileusis (LASIK). Clinical examination revealed 2 distinct corneal infiltrates beneath the LASIK flap. Corneal scrapings were taken for microscopic examination and culture. Both infiltrates initially improved on topical antibiotic therapy, but over the next 18 days, 1 infiltrate worsened and repeat cultures were performed, which demonstrated A fumigatus. Natamycin 5% and amphotericin 0.1% were started and continued for 8 weeks with resolution of the infiltrate and return of the best corrected visual acuity. Delayed-onset multifocal keratitis is a rare complication of LASIK. Fungal entities should be considered in the differential diagnosis.

Topics: Adult; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Eye Infections, Bacterial; Eye Infections, Fungal; Humans; Keratitis; Keratomileusis, Laser In Situ; Male; Natamycin; Staphylococcal Infections; Staphylococcus

The purpose was to report a case of fungal keratitis that occurred following viscocanalostomy.. A 63-year-old man who underwent viscocanalostomy in his left eye presented with pain, redness, watering, and a decrease in visual acuity. Slit lamp examination showed teardrop-like stromal infiltration of the superior cornea. Corneal and conjunctival scrapings were obtained and a corneal biopsy was performed.. Microscopic examination of smears demonstrated no bacteria and fungi. Corneal biopsy revealed dichotomously branching, septate hyphae suggestive of Aspergillus species. Culture identified no microorganism. The patient responded to amphotericin B treatment and the corneal infiltration resolved, leaving a plaquelike corneal scar.. Fungal keratitis may occur after viscocanalostomy, but prompt diagnosis and treatment can preserve the eye.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus; Cornea; Eye Infections, Fungal; Filtering Surgery; Glaucoma; Humans; Keratitis; Male; Middle Aged

To report donor-to-host transmission of Candida albicans after penetrating keratoplasty.. Interventional case report.. A 15-year-old boy who underwent penetrating keratoplasty for keratoconus with donor tissue from a drowning victim developed keratitis and a lenticular abscess 26 days postoperatively.. Candida albicans was cultured from the donor rim and the recipient cornea. Antifungal sensitivity profiles were identical for the two isolates. DNA profiles were identical for both isolates, confirming the donor as the source of the infection.. This case demonstrates the value of routine culture of corneal donor rims and the advisability of close follow-up and possible antifungal prophylaxis when donor rims are positive for fungus.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis; Combined Modality Therapy; Disease Transmission, Infectious; DNA, Fungal; Eye Infections, Fungal; Humans; Keratitis; Keratoconus; Keratoplasty, Penetrating; Male; Microbial Sensitivity Tests; Recurrence; Reoperation; Tissue Donors

To report the first case of fungal keratitis in a patient wearing daily disposable soft contact lenses.. Case Report. A 20-year-old white female in good health developed a corneal ulcer in her lefteye associated with daily disposable soft contact lens wear. There was no history of trauma to the left eye, and she denied overnight wear. Corneal scrapings were taken, and the patient was started on intensive tobramycin 14 mg/mL and cefazolin 50 mg/mL topical therapy for suspected bacterial keratitis. After 3 days of antibacterial therapy, the ulcer worsened. The cultures were negative as were the Gram stain and Gomori's methenamine silver stain. Initial cultures and stains were then repeated with the addition of a culture for herpes simplex virus. The developing clinical picture was suspicious for fungal keratitis. The patient was then started on intensive vancomycin 2%, natamycin 5%, and continued on fortified tobramycin. Three days after the second corneal scrapings were performed, a positive fungal culture was obtained for Fusarium sp. Vancomycin and tobramycin were then discontinued and amphotericin B 0.15% was added to natamycin 5% with the continuation of intensive topical therapy.. The patient's keratitis was successfully treated with intensive double antifungal therapy.. Infectious keratitis in daily disposable soft contact lens wear is an unusual occurrence. To our knowledge, there is no previous case of fungal keratitis occurring in patients wearing daily disposable lenses. This case emphasizes the importance of considering fungus in the differential diagnosis for keratitis even in daily disposable contact lens wearers.

Topics: Adult; Amphotericin B; Contact Lenses, Hydrophilic; Cornea; Disposable Equipment; Drug Therapy, Combination; Eye Infections, Fungal; Female; Fusarium; Humans; Keratitis; Mycoses; Vancomycin

To report two cases of ring infiltrates in disposable contact lens wearers resembling Acanthamoeba keratitis but later identified as fungus.. We report two patients with histories of disposable soft contact lens use, who, on initial presentation, were found to have corneal ring infiltrates and were treated for presumed Acanthamoeba keratitis. Microbiological studies, which included Gram stain and Gomori methenamine silver stain, as well as blood agar, chocolate agar, thioglycolate broth, Sabouraud agar, nonnutrient agar with Escherichia coli overlay, and Lowenstein-Jensen plates, were performed.. Microbiological studies revealed fungi in both cases.. Fungal keratitis is an uncommon complication of disposable soft contact lens use, but it should be considered in the differential diagnosis of corneal ring infiltrates.

Topics: Adult; Amphotericin B; Antifungal Agents; Contact Lenses, Hydrophilic; Cornea; Disposable Equipment; Eye Infections, Fungal; Female; Humans; Keratitis; Mitosporic Fungi; Mycoses; Natamycin

To report an unusual ocular presentation of Candida glabrata in a patient with chronic granulomatous disease.. Interventional case report. A 15-year-old boy with chronic granulomatous disease presented with bilateral limbal infiltrates. He had been receiving broad-spectrum systemic antibiotics for recurrent liver abscesses. The keratitis did not respond to antibiotics and did not resolve after a course of topical steroids.. Corneal cultures revealed Candida glabrata. The same species was simultaneously isolated from the surgical drainage of the liver abscesses. The ocular and hepatic findings resolved on intravenous amphotericin B.. Candida glabrata has recently emerged as an important nosocomial pathogen. It may present as a limbal keratitis in the setting of systemic infection.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Candida; Candidiasis; Cornea; Eye Infections, Fungal; Granulomatous Disease, Chronic; Humans; Keratitis; Liver Abscess; Male; Staphylococcal Infections; Visual Acuity

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

The authors report the first case of Fusarium solani keratitis that progressed to fungal endophthalmitis and was successfully treated with amphotericin B lipid complex (ABLC).. The case of a 34-year-old immunocompetent woman who developed a contact lens-related F. solani keratitis requiring emergency penetrating keratoplasty (PKP) was analyzed. The immunocompetent patient developed fungal endophthalmitis (anterior chamber tap positive for F. solani three months after PKP) and was eventually treated with ABLC.. Systemic amphotericin B (total, 0.42 g) and ketoconazole in addition to topical natamycin and amphotericin did not prove to be effective in eradicating the mycosis in the anterior chamber. Under ABLC treatment (total, 8.79 g), the anterior chamber inflammation resolved completely. No recurrence was observed during an 11-month follow-up after treatment was discontinued.. ABLC proved to be effective in treating F. solani endophthalmitis. It is an important addition to the ophthalmic armamentarium, and appeared to be a better therapeutic agent than standard amphotericin B in this patient.

Topics: Adult; Amphotericin B; Anterior Chamber; Antifungal Agents; Drug Combinations; Endophthalmitis; Eye Infections, Fungal; Female; Fusarium; Humans; Keratitis; Mycoses; Ophthalmic Solutions; Phosphatidylcholines; Phosphatidylglycerols; Visual Acuity

Topics: Aged; Amphotericin B; Anterior Chamber; Antifungal Agents; Cornea; Endophthalmitis; Eye Infections, Fungal; Female; Flucytosine; Graft Rejection; Humans; Iris; Keratitis; Keratoplasty, Penetrating; Recurrence; Reoperation; Saccharomyces; Vitrectomy; Vitreous Body

This study aimed to present two patients with delayed-onset, endogenous fungal keratitis after treatment for fungal endophthalmitis after cataract surgery.. The authors retrospectively reviewed the clinical course of two patients in whom deep stromal fungal keratitis developed 2 weeks and 3 months, respectively, after apparent successful aggressive therapy for fungal endophthalmitis. Before the onset of the keratitis, both patients underwent vitrectomies with intraocular injection of 7.5 to 10.0 mcg amphotericin B, as well as treatment with systemic fluconazole and topical antifungal therapy. In case 1, a pre-existing prosthetic intraocular lens and lens capsular bag were removed at the time of vitrectomy, whereas in case 2, the intraocular lens was left in place and a posterior capsulectomy was performed.. The keratitis worsened in both patients, despite intensive systemic and topical antifungal therapy. Both patients underwent therapeutic penetrating keratoplasties. In case 1, this resulted in successful resolution of the infection and no recurrences 3 months after the transplant. The corneal transplant was complicated by an expulsive choroidal hemorrhage in the other patient. Fusarium solani was cultured from the initial vitrectomy specimen in patient 1, and although it was not cultured from the keratitis, septate hyphal elements were present on histopathologic examination. The causative organism in case 2 was Acremonium kiliense, which was cultured from both the original vitrectomy specimen and the deep corneal stromal infiltrate.. Fungal organisms may not be eradicated completely from eyes with endophthalmitis despite aggressive therapy and apparent initial successful treatment. These patients need to be monitored for prolonged periods, and treatment should be reinitiated at the earliest sign of recrudescence of infection.

Topics: Acremonium; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Cataract Extraction; Corneal Stroma; Endophthalmitis; Eye Infections, Fungal; Female; Fluconazole; Fusarium; Humans; Keratitis; Keratoplasty, Penetrating; Lenses, Intraocular; Male; Mycoses; Retrospective Studies; Vitrectomy

To report a case of Arthrographis kalrae keratitis and to note that its clinical manifestation resembles Acanthamoeba corneal infection.. Case report.. The patient's keratitis was caused by A kalrae, a very rare soil fungus.. Arthrographis kalrae can cause a keratitis that manifests with severe photophobia and a slowly progressive corneal infiltrate whose symptoms can mimic Acanthamoeba. Our patient most likely acquired the fungus from exposure to soil and not from her contact lenses.

Topics: Administration, Oral; Amphotericin B; Antifungal Agents; Contact Lenses; Cornea; Eye Infections, Fungal; Female; Humans; Keratitis; Ketoconazole; Light; Middle Aged; Mitosporic Fungi; Mycoses; Ophthalmic Solutions; Vision Disorders

Cysts of 2 isolates of Acanthamoeba from the cornea of 2 patients with confirmed Acanthamoeba keratitis were tested in vitro for sensitivity to antimycotic agents such as fluconazole, miconazole, amphotericin-B, pimaricin, antiprotozoal agents such as pentamidine isetionate and antiseptics which could be use in the ophthamological region. Pimaricin was the most successful cysticidal agent against the two strains. Sensitivity to pentamidine isetionate showed variation. Fluconazole, miconazole and amphotericin-B were resistant against cysts with concentration of eye drops that have been used in the treatment of Acanthamoeba keratitis. It was supposed that 5% pimaricin eye drops could be use in the treatment of Acanthamoeba keratitis in addition to keratomycosis. Pentamidine isetionate which belong to the diamidine family, is not yet clear as to the side effects to corneal epithelium cell, but we believe that this drug could be expected as a new therapeutic agent for Acanthamoeba keratitis.

Topics: Acanthamoeba; Amphotericin B; Animals; Anti-Infective Agents, Local; Antifungal Agents; Antiprotozoal Agents; Cornea; Fluconazole; Humans; Keratitis; Miconazole; Natamycin; Pentamidine

Four patients presented after cataract surgery with delayed-onset endophthalmitis caused by Acremonium kiliense with in vitro sensitivity to amphotericin B. In all patients, ocular infection was recalcitrant to single-dose intravitreous amphotericin B injection. The authors reviewed the management of endophthalmitis caused by A. kiliense and presented treatment recommendations.. The authors retrospectively evaluated a cluster of four patients with delayed-onset postoperative endophthalmitis after phacoemulsification with posterior chamber intraocular lens implantation. All patients underwent vitreous sampling, intravitreous injection of amphotericin B, and systemic administration of fluconazole. Pars plana vitrectomy was performed in all patients for management of either primary (1 eye) or persistent infection (3 eyes). Two patients with persistent infection also underwent surgical explanation of their posterior chamber intraocular lens.. Worsening infection developed in three of three eyes that underwent vitreous aspiration with intravitreous injection 5 micrograms amphotericin B. These patients subsequently responded to vitrectomy followed by additional intravitreous amphotericin B injection. One eye underwent primary vitrectomy and intravitreous injection of 7.5 micrograms amphotericin B. Although treatment of the initial infection was successful, fungal keratitis developed in this patient 3 months after presentation. Visual outcome was variable, ranging from visual acuity of 20/25 to no light perception with follow-up of 2 years. Epidemiologic investigation suggested a common environmental source for the A. kiliense organisms.. Single-dose administration of intravitreous amphotericin B was inadequate treatment for fungal endophthalmitis caused by A. kiliense. Vitrectomy with repeated intravitreous administration of amphotericin B may be necessary to eradicate intraocular function caused by this organism.

Topics: Acremonium; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Aqueous Humor; Endophthalmitis; Eye Infections, Fungal; Female; Humans; Injections; Keratitis; Lenses, Intraocular; Male; Microbial Sensitivity Tests; Middle Aged; Mycoses; Phacoemulsification; Postoperative Complications; Retrospective Studies; Visual Acuity; Vitrectomy; Vitreous Body

We report on a case of keratitis with hypopion by Fusarium monilinforme, in a patient with palpebral retraction and light exophthalmos caused by hyperthyroidism. We emphasize the importance of the microscopic examination of bioptic material and the identification of fungal species: the first permits an early diagnosis, the second the adoption of a targeted and effective therapy. In our case, the ocular infection was successfully treated with antimycotic drugs used topically.

Topics: Aged; Amphotericin B; Antifungal Agents; Cornea; Female; Fusarium; Humans; Keratitis; Miconazole; Mycoses

We reported three consecutive cases of severe fungal keratitis initially undiagnosed by corneal scrapping. Corneal biopsy showed fungal elements of Paecilomyces lilacinus, Fusarium solani, Scedosporium apiospermum. Most cases of fungal keratitis could be treated successfully if adequate antifungal therapy were started early. Early and accurate diagnosis is of major importance. The results of our cases confirm the superiority of corneal biopsy over corneal scrapping. Corneal biopsy is a procedure of choice in suspected cases of keratomycosis in which corneal scrapings fail.

Topics: Abscess; Aged; Amphotericin B; Biopsy; Contact Lenses; Cornea; Corneal Ulcer; Female; Humans; Keratitis; Male; Mycoses; Time Factors

Topics: Administration, Topical; Aged; Amphotericin B; Chloramphenicol; Drug Resistance, Microbial; Drug Therapy, Combination; Eye Infections, Fungal; Humans; Keratitis; Male; Mitosporic Fungi

Keratomycosis still represents a major problem in ophthalmology because of diagnostic and therapeutic difficulties. This is caused by difficult clinical differentiation and problems in microbiological analysis due to pretreatment and lack of sample material in early stages of the infection.. A 16-year-old female contact lens wearer suffered from a monocular central stromal opacification of the cornea. Analysis of the contact lens storage case liquid (CLCL) was based on investigation of the direct sample, Gram and Lactophenol staining and on specific cultures for aerobic bacteria, anaerobic bacteria and fungi.. The patient suffered from a mycotic keratitis caused by Acremonium kiliense. First microbiological results were obtained from the CLCL subsequently confirmed from aqueous and from cornea tissue after keratoplasty. Continuation of the systemic Itraconazol therapy resulted in cure and improvement of the visual acuity.. Success factors for diagnosis and therapy are early detection of the causative agent in the cornea and/or in the contact lens storage case as well as diagnosis related intensive drug therapy and eventually surgical intervention.

Topics: Acremonium; Administration, Oral; Adolescent; Amphotericin B; Antifungal Agents; Contact Lenses; Drug Therapy, Combination; Female; Fluconazole; Humans; Itraconazole; Keratitis; Ketoconazole; Mycoses; Ophthalmic Solutions; Therapeutic Irrigation

Topics: Adult; Amphotericin B; Candidiasis; Eye Infections, Fungal; Female; Humans; Keratitis; Keratotomy, Radial; Ketoconazole

We evaluated the effect of collagen shields presoaked with amphotericin B on the treatment of experimental Candida albicans-induced keratitis. Treatment results were compared to those of amphotericin B eyedrops instilled hourly. Forty-eight albino rabbits received intrastromal injections of 10(8) C. albicans organisms. Twenty-four hours later, eyes were treated for eight hours each day with hourly instillation of 0.15% amphotericin B drops, hourly instillation of saline drops, or application of a collagen shield presoaked in 0.5% amphotericin B for one hour. The rabbits were killed after one, three, or five days of treatment. Quantitation of fungi in the cornea was achieved by culturing homogenates and counting colony-forming units. Treatment with amphotericin B applied either as hourly instilled drops or absorbed in collagen shields significantly (P less than .05) reduced corneal fungal counts at all time points when compared to saline-treated control eyes. Rabbit eyes treated with amphotericin B-soaked collagen shields had significantly lower fungal counts compared with hourly instilled amphotericin B drops at Days 1 (P = .02) and 3 (P = .04), but not at Day 5. The collagen shields were as effective in reducing the number of colony-forming units as were amphotericin B drops at Day 5. These data suggest that collagen shields soaked in amphotericin B could be a useful and convenient treatment device in keratomycosis such as that caused by C. albicans.

Topics: Administration, Topical; Amphotericin B; Animals; Biological Dressings; Candida albicans; Candidiasis; Collagen; Colony Count, Microbial; Drug Carriers; Eye Infections, Fungal; Keratitis; Rabbits

A 71-year-old patient had a stromal infiltration at the donor-recipient interface two years after penetrating keratoplasty while wearing a "piggyback-type" contact lens. The corneal graft sutures in the affected area had been removed one year previously. Corneal scraping revealed the presence of Candida parapsillosis, and the infection was treated successfully with a combination of amphotericin B and flucytosine. The association between contact-lens wear and fungal infections of corneal grafts is discussed.

Topics: Aged; Amphotericin B; Candida; Candidiasis; Contact Lenses; Cornea; Eye Infections, Fungal; Female; Flucytosine; Humans; Keratitis; Keratoplasty, Penetrating; Postoperative Complications

After intrastromal injection of a standardized inoculum of Candida albicans blastoconidia in Dutch-belted rabbits, the efficacy of subconjunctival therapy with amphotericin B and miconazole was evaluated using a quantitative isolate recovery technique. The subconjunctival injection of miconazole resulted in the recovery of significantly more viable organisms compared to the number recovered in controls (2,000 micrograms daily, P less than .02; 3,000 micrograms daily, P less than .01, respectively). Amphotericin B, in contrast, in dosages of 500 or 1,500 micrograms daily, had a significant therapeutic effect (P less than .03). The anomalous response to subconjunctival therapy with miconazole seen in this model suggests an effect on host defense mechanisms.

Topics: Amphotericin B; Animals; Candida albicans; Candidiasis; Conjunctiva; Dose-Response Relationship, Drug; Keratitis; Miconazole; Rabbits

A group of ten Candida albicans strains previously determined to be resistant or susceptible to topical amphotericin B in vivo and in vitro were exposed to treatment with different concentrations of the drug in a quantitative model of candidal keratitis in Dutch-belted rabbits. After 5 days of topical treatment with amphotericin B eye drops in concentrations of 0.3%, 0.03%, or 0.003%, quantitative isolate recovery in treated animals was compared with that of untreated controls. A dose response was observed for all five susceptible strains. The two strains that were most sensitive to amphotericin B in vitro also were the most susceptible in vivo. At each dose level there was a two- to eightfold reduction in isolate recovery among highly susceptible strains compared with less susceptible strains (P less than 0.05). The five resistant strains remained so even when the 0.3% concentration was used. Among strains of C. albicans susceptible to amphotericin B, there appeared to be a variation in degree of susceptibility in vivo that correlated with the minimum inhibitory concentration.

Topics: Administration, Topical; Amphotericin B; Animals; Candida albicans; Candidiasis; Colony Count, Microbial; Cornea; Dose-Response Relationship, Drug; Drug Resistance, Microbial; Eye Infections, Fungal; Humans; Keratitis; Rabbits

A case of fungal keratitis caused by Scopulariopsis brevicaulis following a penetrating eye injury is described. Treatment with antifungal agents and keratoplasty resulted in a favourable outcome.

Topics: Adult; Amphotericin B; Antifungal Agents; Combined Modality Therapy; Eye Infections, Fungal; Humans; Itraconazole; Keratitis; Keratoplasty, Penetrating; Ketoconazole; Male; Mitosporic Fungi

We compared the efficacy of two polyenes, amphotericin B and natamycin, in two models of yeast infection. In one, treatment was begun immediately after inoculation, in the other it was delayed 24 hours. In each model infection with Candida albicans was established in the corneal stroma of dutch-belted rabbits and treated topically with 5% natamycin or amphotericin B 0.15% and 0.075%. Quantitative isolate recovery techniques were used to assess response after 5 days of treatment. A significant therapeutic effect was present for amphotericin B in both models. However, delayed treatment with natamycin was ineffective using treatment schedules efficacious when begun 1 hour after inoculation. A therapeutic effect was present only with administration of the drug every 1/2 hr. This altered response may reflect a difference in susceptibility between different growth phases in yeasts.

Topics: Administration, Topical; Amphotericin B; Animals; Candida albicans; Candidiasis; Corneal Stroma; Keratitis; Natamycin; Polyenes; Rabbits

The susceptibility of Candida albicans to topical amphotericin B and natamycin was evaluated in a model of stromal keratitis in Dutch-belted rabbits and compared with minimal inhibitory concentrations in vitro. Treatment was delayed 24 hr to allow invasive disease to occur and was then continued for 5 days. Ten strains of Candida albicans comprised the test panel. For amphotericin B, the minimal inhibitory concentration (MIC) by tube dilution classified the same strains as resistant or susceptible as did the in vivo response. A dose-response was observed with different concentrations of the drug. For natamycin, the MIC misclassified two strains. The rate of administration of natamycin required in this model was much higher than for amphotericin B, a therapeutic effect being observed with natamycin only when the drug was administered every 30 min during the in vivo efficacy and in vitro susceptibility with these strains is in agreement with that observed in the authors' previous studies using a model of immediate treatment.

Topics: Administration, Topical; Amphotericin B; Animals; Candida albicans; Candidiasis; Disease Models, Animal; Dose-Response Relationship, Drug; Keratitis; Microbial Sensitivity Tests; Natamycin; Rabbits

The efficiency of Amphotericin B drops was studied using a newly developed keratomycosis model (defined strain Candida albicans DSM 70010, which leads reproducibly to a corneal infection with descemetocele without prior local or systemic immunosuppression in the rabbit). Penetration of the drug (administered ten times a day) into the cornea and aqueous humor was only demonstrated after abrasion of the corneal epithelium. Three groups were studied: (I) therapy with abrasion, (II) therapy without abrasion, and (III) a control group. Both clinically (descemetocele or perforation, hypopyon) and with regard to microbiology (reculture of Candida) the results obtained in Group I were significantly better than those obtained in Group II (p less than 0.001). Repeated corneal abrasion is therefore recommended for treatment of Candida keratitis with Amphotericin B.

Topics: Amphotericin B; Animals; Biological Availability; Candidiasis; Keratitis; Male; Ophthalmic Solutions; Rabbits

The effect of corticosteroid treatment in addition to antimycotic therapy was studied on the basis of a newly developed keratomycosis model. Forty-eight hours after intracorneal injection of a defined strain of Candida albicans, Amphotericin B drops were administered at one-hour intervals ten times a day. To improve penetration of the drops abrasion of the corneal epithelium was performed every three days. In addition, 4 mg of dexamethasone phosphate was injected subconjunctivally into one eye every two days. The results showed that in this low dosage dexamethasone did not worsen the course of the infection in a single case. On the contrary, there was significantly less neovascularization (p less than 0.05) than in the group not treated with dexamethasone. It therefore appears that combination thereby is the best form of treatment for keratomycosis; this is also supported by clinical observations.

Topics: Amphotericin B; Animals; Candidiasis; Cornea; Dexamethasone; Drug Therapy, Combination; Keratitis; Male; Rabbits

An experimental Keratitis study of Aspergillus fumigatus was performed in 130 rabbits divided into 12 groups of ten animals each. Three antifungal drugs (myconazole, amphotericin B and pimaricin) were tested using two procedures (topical drops and subconjunctival injections) and two different concentrations (500 and 10 000 times the MIC). In each case, the drugs were applied every 3 h starting 14 h after inoculation. Miconazole was useful at 10 mg/ml concentration by topical drops and subconjunctival injections, but was less useful at 5 mg/ml. Amphotericin B was useful at 5 mg/ml concentration by topical drops and less useful at 2 mg/ml. No differences were found between the two concentrations by subconjunctival administration. Pimaricin was useful by topical drops at 50 mg/ml concentration and less useful at 10 mg/ml as well as by subconjunctival injections.

Topics: Administration, Topical; Amphotericin B; Animals; Aspergillosis; Aspergillus fumigatus; Conjunctiva; Dose-Response Relationship, Drug; Drug Evaluation, Preclinical; Female; Injections; Keratitis; Male; Miconazole; Natamycin; Rabbits

Experimental designs in ophthalmologic research frequently treat both eyes of a subject in the same fashion: e.g., therapy with a specific drug or control. In these two-eye designs, observations from the same subject are often positively correlated. Failure to account for this correlation is a serious error which overstates the precision of studies, resulting in falsely significant results. This paper reviews the statistical methods appropriate for studies where endpoints are quantitative. We present: (1) the use of analysis of variance (t-test when there are 2 treatment conditions) to estimate differences between all experimental treatments, (2) the use of contrasts to estimate differences between specific treatments, and (3) methods for analysis of data from multiple experiments. Because of the ubiquity of incorrect analysis of data from two-eye designs in the ophthalmologic research literature and the serious consequences of this error, we propose a limited statistical review of manuscripts to ascertain if the statistical analysis matched the experimental design.

Topics: Amphotericin B; Analysis of Variance; Animals; Candidiasis; Eye Diseases; In Vitro Techniques; Keratitis; Ketoconazole; Ophthalmology; Rabbits; Statistics as Topic

The influence of topical corticosteroid on the efficacy of five topical antifungal agents was evaluated in a standardized rabbit model of Candida keratitis using a quantitative mycologic technique. Topical 1% prednisolone acetate worsened the disease when given alone and adversely influenced the efficacy of 5% natamycin, 1% flucytosine, and 1% miconazole when given in combination. The efficacy of amphotericin B appeared unaffected when the antifungal agent was administered in concentrations of 0.5% and 0.15%. The adverse effect of the topical corticosteroid appeared to be inversely related to the efficacy of the antifungal agent in vivo.

Topics: Adrenal Cortex Hormones; Amphotericin B; Animals; Antifungal Agents; Candida albicans; Candidiasis; Drug Resistance, Microbial; Drug Therapy, Combination; Flucytosine; Keratitis; Ketoconazole; Miconazole; Natamycin; Rabbits

Topics: Adult; Amphotericin B; Aspergillosis; Corneal Ulcer; Female; Humans; Keratitis

Topics: Amphotericin B; Animals; Cornea; Fusarium; Keratitis; Mitosporic Fungi; Peptide Hydrolases; Phosphoric Monoester Hydrolases; Rabbits; Rhizoctonia

A strain of Fusarium solani (Mart.) Sacc. (IMI-216517), isolated from a patient of mycotic keratitis, produced experimental keratomycosis in albino rabbit cornea and survived in internal tissues of albino mice for varying periods. Alantolactone, isolated from the plant - Inula racemosa Hook. f. exhibited marked in vitro fungistatic activity against this strain of F. solani at 100-200 microgram/ml concentrations. The strain was less sensitive to amphotericin B and showed more acid than alkaline proteinase and phosphatase activities.

Topics: Adult; Amphotericin B; Animals; Antifungal Agents; Fusarium; Humans; Keratitis; Lactones; Male; Mice; Mycoses; Organotin Compounds; Peptide Hydrolases; Phosphoric Monoester Hydrolases; Rabbits; Sesquiterpenes; Thiocarbamates

Several manifestations of equine corenal ulcers caused by mycotic agents are discussed. Antifungal therapy is reviewed. Mycotic keratitis should be suspected when routine corneal ulcer therapy is nonproductive.

Topics: Amphotericin B; Animals; Clotrimazole; Horse Diseases; Horses; Keratitis; Mycoses; Natamycin; Nystatin

In a model of experimental Candida albicans keratitis in rabbits, treatment with a combination of amphotericin B and rifampin was compared with treatment with amphotericin B alone. Both modes of therapy substantially reduced the number of organisms in the cornea below the number in untreated control corneas. In the group treated with combined therapy, there were significantly fewer organisms in the cornea after three days of therapy than in the group treated with amphotericin B alone. The results of this study indicate that the treatment of C albicans keratitis in rabbits with combined amphotericin B and rifampin is more effective than treatment with amphotericin B alone.

Topics: Amphotericin B; Animals; Candidiasis; Drug Therapy, Combination; Female; Keratitis; Male; Rabbits; Rifampin

The author presents a case of exogenous, retrocorneal, limbal infiltration due to chromomycosis, following cataractextraction. Since the etiology of this keratitis was not recognized at the beginning, steroids were applied causing an exacerbation of the keratitis with hypopyoniritis. A perforating, excentric keratoplasty was performed, yielding material for the histological diagnosis, and for the identification of the responsible agent. The cultural and morphological properties were typical of those of a dematiaceous fungus, a chromomycosis. In vitro studies demonstrated this fungus to be less sensitive to 5-fluorcytosin and clotrimazole, and to be less resistant to natamycin, mystatin and amphotericin-B, paving the road for an effective conservative therapy following surgery.

Topics: Amphotericin B; Chromoblastomycosis; Cornea; Female; Humans; Keratitis; Middle Aged

Four cases of human keratitis caused by the tropical fungus Lasiodiplodia theobromae have been encountered in Miami, Florida bringing to 8 the number of cases reported in the world literature. Two of the ulcers were mild. Three patients recovered without severe impairment of vision after topical polyene treatment, but 1 patient with a severe ulcer required therapeutic keratoplasty after 11 days of topical natamycin. Histopathology revealed fungus deep in the cornea, invading Descemet's membrane. L. theobromae appeared to have collagenase activity in vitro. Inoculation of L. theobromae into the corneas of rabbits produced progressive ulcers. The fungus was endemic in Miami on home grown and imported bananas. Polyene antimycotic antibiotics were fungicidal for L. theobromae in vitro. Thiabendazole was effectively fungistatic but varied in fungicidal effect. Clotrimazole and miconazole were only incompletely fungistatic. Of 7 strains of L. theobromae tested, 4 were relatively resistant to 5-flurocytosine.

Topics: Adolescent; Adult; Aged; Amphotericin B; Animals; Cornea; Corneal Ulcer; Female; Humans; Keratitis; Male; Middle Aged; Mitosporic Fungi; Mycoses; Natamycin; Rabbits

Candida albicans was the most common fungus responsible for mycotic keratitis in our series from a northern climate, as opposed to southern climates where other fungi were more common. Pimaricin was effective in our patients with Candida infections and in one patient with Aspergillus infection that had been unresponsive to previous amphotericin B.

Topics: Acetazolamide; Aged; Agricultural Workers' Diseases; Amphotericin B; Aspergillosis; Atropine; Candidiasis; Corneal Ulcer; Cyclopentanes; Dimethylamines; Eye Injuries; Female; Gentamicins; Humans; In Vitro Techniques; Keratitis; Male; Middle Aged; Mycoses; Natamycin; Neomycin; Phenylacetates; Polymyxins; Staphylococcal Infections; Tyrothricin; Wisconsin

Clinical and laboratory features of 16 cases of keratitis that were caused by dematiaceous pigmented fungi are reported. Management, including the treatment of nine cases with Natamycin (Pimaricin), resulted in corneal healing in 14 cases, and therapeutic surgery in two cases.

Topics: Administration, Topical; Adolescent; Adult; Amphotericin B; Child; Chromoblastomycosis; Corneal Ulcer; Female; Gentamicins; Humans; Keratitis; Middle Aged; Mycoses; Natamycin; Visual Acuity

Topics: Adult; Aged; Amphotericin B; Anterior Chamber; Aspergillosis; Aspergillus fumigatus; Candida albicans; Candidiasis; Cryptococcosis; Cryptococcus neoformans; Cytosine; Drug Resistance, Microbial; Female; Flucytosine; Humans; Keratitis; Kidney Diseases; Kidney Transplantation; Male; Meningitis; Middle Aged; Mycoses; Transplantation, Homologous

Topics: Amphotericin B; Animals; Aspergillosis; Candidiasis; Eye Diseases; Humans; Keratitis; Mycoses; Natamycin; Nystatin; Rabbits

Topics: Amphotericin B; Antifungal Agents; Evaluation Studies as Topic; Eye Diseases; Flucytosine; Humans; Imidazoles; Keratitis

Topics: Amphotericin B; Antifungal Agents; Corneal Ulcer; Fusarium; Humans; Keratitis; Microbial Sensitivity Tests; Mycoses; Natamycin; Visual Acuity

Topics: Amphotericin B; Animals; Aspergillosis; Candidiasis; Cornea; Iritis; Keratitis; Natamycin; Nystatin; Potassium; Potassium Iodide; Rabbits; Sodium

Topics: Adult; Aged; Amphotericin B; Anti-Bacterial Agents; Candida; Child; Cornea; Cortisone; Eye Diseases; Female; Griseofulvin; Humans; Keratitis; Male; Middle Aged; Mycoses; Nystatin

Topics: Amphotericin B; Animals; Antifungal Agents; Aspergillus; Benzalkonium Compounds; Candida; Copper; Corneal Ulcer; Dexamethasone; Drug Synergism; Injections; Iritis; Keratitis; Mycoses; Nystatin; Ophthalmic Solutions; Potassium Iodide; Pyridines; Rabbits; Sulfates

Topics: Adult; Amphotericin B; Corneal Transplantation; Corneal Ulcer; Humans; Keratitis; Male; Mycoses; Nystatin; Pseudallescheria

Topics: Amphotericin B; Animals; Chymotrypsin; Drug Therapy; Keratitis; Mycoses; Rabbits; Research

Topics: Acremonium; Amphotericin B; Aqueous Humor; Blood; Cataract Extraction; Drug Therapy; Endophthalmitis; Eye Diseases; Geriatrics; Humans; Injections, Intravenous; Keratitis; Mycoses; Pharmacology; Postoperative Complications; Uveitis

Topics: Amphotericin B; Antifungal Agents; Bacteriological Techniques; Conjunctivitis; Diagnosis; Eye Infections, Fungal; Eyelids; Humans; Keratitis; Lacrimal Apparatus; Mycoses; Ophthalmology; Postoperative Complications; Skin Tests; Uveitis

Topics: Agammaglobulinemia; Amphotericin B; Anti-Bacterial Agents; Blood Protein Electrophoresis; Cycloheximide; Drug Therapy; Fusarium; Humans; Iodides; Keratitis; Mycoses; Toxicology

Topics: Amphotericin B; Corneal Ulcer; Debridement; Humans; Keratitis; Mycoses

Topics: Amphotericin B; Bacteriological Techniques; Candida; Corneal Ulcer; Eye Infections, Fungal; Fungi; Humans; Keratitis; Steroids; Toxicology