A Case Report of Intracameral Amphotericin B Injection in the Management of Deep Keratomycosis

ABSTRACT

PURPOSE: The management of fungal keratitis can be difficult because fungi are capable of penetrating the intact Descemet's membrane and entering the anterior chamber and because ocular penetration of topical antifungal agents is poor. The authors report the first case of intracameral amphotericin B injection in the management of deep keratomycosis. METHODS: A 73-year-old woman developed pain and decreased vision in her right eye. Corneal ulcer with hypopyon was found, and 10% KOH smear revealed hyphae. There was an initial response after administrating topical amphotericin B along with systemic fluconazole. But deep infiltrates and hypopyon remained. The corneal scraping grew Fusarium on culture. Ten micrograms of amphotericin B in 0.1 mL was injected into the anterior chamber on day 22 after admission. Two months after the intracameral injection, the ulcer and hypopyon cleared completely leaving only a central corneal scar. RESULTS: The results were favorable, with the ulcer and hypopyon clearing completely after the intracameral injection of amphotericin B. CONCLUSIONS: Intracameral amphotericin B may be a useful modality in the treatment of deep keratomycosis not responding to topical antifungal agents.