amphotericin-b and Scleritis

Ocular bee stings are known to cause corneal melts, corneal infiltrates, cataracts, and secondary glaucoma. Our patient presented with scleritis, corneal infiltrates, and endophthalmitis after a ocular bee sting. Topical treatment led to resolution of anterior segment inflammation, but the scleritis and vitreous inflammation worsened. Vitrectomy with intravitreal antibiotics was done and scrapings from the scleral abscess showed growth of Aspergillus fumigatus on culture. Repeat vitrectomy with silicone oil was needed for retinal detachment. Oral and intravitreal antifungals led to resolution of inflammation with attached retina. This is the first reported case of bee sting-induced fungal endophthalmitis with scleritis.

Topics: Adult; Amphotericin B; Animals; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Bees; Bites and Stings; Dexamethasone; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Fungal; Glucocorticoids; Humans; Itraconazole; Male; Scleritis; Vitrectomy; Vitreous Body

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

Topics: Adult; Amphotericin B; Antifungal Agents; Diagnosis, Differential; Eye Infections, Fungal; Female; Humans; Instillation, Drug; Ophthalmic Solutions; Rhodotorula; Sclera; Scleritis

A 68-year-old woman presented with pain in her left eye. Necrosis with calcium plaques was observed on the medial part of the sclera. Aspergillus fumigatus was isolated from the culture of the necrotic area. On systemic work-up including serum and urine electrophoresis studies, the serum monoclonal protein of immunoglobulin G was detected. The patient was diagnosed with monoclonal gammopathy of undetermined significance and fungal scleritis. Despite intensive treatment with topical and oral antifungal agents, scleral inflammation and ulceration progressed, and scleral perforation and endophthalmitis developed. Debridement, antifungal irrigation, and tectonic scleral grafting were performed. The patient underwent a combined pars plana vitrectomy with an intravitreal injection of an antifungal agent. However, scleral and intraocular inflammation progressed, and the eye was enucleated. Aspergillus fumigatus was isolated from the cultures of the eviscerated materials. Giemsa staining of the excised sclera showed numerous fungal hyphae.

Topics: Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Disease Progression; Eye Enucleation; Female; Humans; Injections, Intraocular; Paraproteinemias; Sclera; Scleritis; Ultrasonography; Vitrectomy

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 report the clinical picture and outcome of fungal infection of self-sealing wounds in cataract surgery.. Retrospective noncomparative case series.. Seven postoperative cataract patients.. Seven consecutive patients who underwent cataract surgery in different locations in India and developed microbiologically proven fungal infection of the surgical wound were included. All were managed at a tertiary eye care center in India between May 2001 and April 2002.. The data reviewed included patient age, gender, onset of symptoms after surgery, examination findings at the time of onset of symptoms and referral, laboratory workup, treatment, and outcome. The cataract surgeons involved were contacted to determine their cataract practice and to determine any possible breach in the sterile technique.. The median interval to onset of symptoms after cataract surgery was 5.0 days (mean, 5.8 days; range, 3-9 days). The initial diagnoses at the time of onset of symptoms were keratitis (n = 3), scleritis (n = 1), and excessive anterior chamber reaction (n = 3). The last 4 patients were treated with topical and/or systemic corticosteroid therapy before referral. All cases subsequently developed deep keratitis. Specimens for microbiology workup were obtained by scrapings (n = 6), corneoscleral biopsy (n = 4), and anterior chamber paracentesis (n = 4). Organisms identified were Aspergillus flavus (n = 2), Aspergillus terreus (n = 2), Aspergillus spp. (n = 2), and Candida albicans (n = 1). The infection resolved with medical therapy in 2 cases; the final visual acuity was 20/125 in one case and 20/20 in the other case. The infection progressed to endophthalmitis in 5 eyes, resulting in complete loss of vision. The source of infection could not be identified in any case.. Infection of self-sealing tunnel incision for cataract surgery is a diagnostic and therapeutic challenge.

Topics: Aged; Aged, 80 and over; Amphotericin B; Aspergillosis; Candidiasis; Corneal Ulcer; Drug Therapy, Combination; Eye Infections, Fungal; Female; Fluconazole; Humans; Ketoconazole; Male; Minimally Invasive Surgical Procedures; Natamycin; Phacoemulsification; Retrospective Studies; Scleritis; Surgical Wound Infection; Suture Techniques

We report a case of scleritis caused by Aspergillus fumigatus. The infection was successfully treated with antifungal drugs, cryotherapy and dura mater grafting. A 67-year-old man developed a scleral ulcer 2 months after suffering a trauma in his right eye caused by the branch of a tree. Diagnosis was made after biopsy of a scleral nodule. Scrapings showed hyphal fragments and cultures were positive for Aspergillus fumigatus. Although therapy with oral fluconazol and topical amphotericin B was begun, the scleritis continued to worsen, so cryotherapy and dura mater grafting were performed. The patient showed no signs of infection for 8 months after discontinuation of antifungal drugs.

Topics: Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Cryotherapy; Dura Mater; Eye Infections, Fungal; Eye Injuries; Fluconazole; Humans; Male; Scleritis