Severe pigmented keratitis caused by Cladorrhinum bulbillosum.

We report a case of severe pigmented keratitis with poor prognosis, caused by Cladorrhinum bulbillosum. Antifungal treatment with topical natamycin and fluconazole eye drops and oral tablet fluconazole failed to heal the ulcer and resulted in perforation. The causative fungus, C. bulbillosum, was identified on the basis of its typical microscopic features and 98% sequence homology to ex-type isolate CBS 304.90 (accession no. FM955448). The results of an in vitro antifungal susceptibility test indicated that the isolate was susceptible to natamycin, amphotericin B, fluconazole and itraconazole. The present case is the third case of keratitis and the second case of human keratitis. Compromised immunity due to liver cirrhosis could lead to a failed prognosis even when the fungal isolate is highly susceptible to antifungal treatment.

First report of evaluation of K-M media: a new corneal preservation medium.

PURPOSE: To analyze the outcome of keratoplasty performed using Kalevar-Majumdar (K-M) media, a new synthetic viscous medium for preservation of the cornea. MATERIALS AND METHODS: The K-M media-preserved donor eye balls were kept in a bottle in a refrigerator at 4 degrees C till the corneas were used. Forty-eight consecutive keratoplasty cases of pseudophakic bullous keratopathy with vision less than counting fingers at one meter and operated by a single surgeon have been analyzed. Corneal donor button of 7.5 mm was used on the 7.0 mm recipient bed in all cases. Surgery was done with a standard technique. All the cases were examined daily for the first week and at the end of one month for graft clarity, epithelial defect and stromal edema. RESULTS: The K-M media-preserved corneal grafts remained clear at the end of the first week in 95.8% (46 of 48) cases and at the end of one month in 93.7% (45 of 48) cases. Donor epithelial haze cleared in 24 h in all cases. The stromal edema got cleared in the majority (91.7%, 44 of 48) within 24 h. Epithelial defect was seen in only 10.4% (five cases). There was no primary graft failure. CONCLUSION: K-M medium, a new viscous, synthetic corneal preservation medium, is a safe (no primary donor failure) alternative to conventional liquid corneal preservation media. K-M media-preserved eyes appear to have better preserved corneal epithelium with faster achievement of graft clarity postoperatively.