Corneal Collagen Cross-Linking for the Management of Mycotic Keratitis.

PURPOSE: To evaluate the efficiency of corneal collagen cross-linking (CXL) in addition to topical voriconazole in cases with mycotic keratitis. DESIGN: Retrospective case series in a tertiary university hospital. PARTICIPANTS: CXL was performed on 13 patients with mycotic keratitis who presented poor or no response to topical voriconazole treatment. METHODS: The clinical features, symptoms, treatment results and complications were recorded retrospectively. The corneal infection was graded according to the depth of infection into the stroma (from grade 1 to grade 3). The visual analogue scale was used to calculate the pain score before and 2 days after surgery. MAIN OUTCOME MEASURES: Grade of the corneal infection. RESULTS: Mean age of 13 patients (6 female and 7 male) was 42.4 ± 17.7 years (20-74 years). Fungus was demonstrated in culture (eight patients) or cytological examination (five patients). Seven of the 13 patients (54%) were healed with topical voriconazole and CXL adjuvant treatment in 26 ± 10 days (15-40 days). The remaining six patients did not respond to CXL treatment; they initially presented with higher grade ulcers. Pre- and post-operative pain score values were 8 ± 0.8 and 3.5 ± 1, respectively (p < 0.05). CONCLUSIONS: The current study suggests that adjunctive CXL treatment is effective in patients with small and superficial mycotic ulcers. These observations require further research by large randomized clinical trials.

Argon laser phototherapy in the treatment of refractory fungal keratitis.

PURPOSE: To report the beneficial properties of argon laser as an adjunctive therapy in 2 patients with refractory fungal keratitis. METHODS: Case reports and a review of the literature. Two cases of Fusarium keratitis refractory to topical and systemic antifungals were further treated with argon laser. Before laser treatment, the eye was medicated with proparacaine 0.5%, lidocaine 4%, and a single drop of fluorescein sodium 0.25%. Argon laser irradiation of the affected cornea was performed using argon blue-green wavelength (Coherent Ultima 2000; Coherent, Inc). A spot size of 500 µm, pulse duration of 0.10 seconds, and power ranging from 500 to 900 mW were used. RESULTS: During the first week after laser treatment, both patients showed complete resolution of the infiltrates. Two signs were observed during the procedure: a blanching of the corneal stroma and small cavitations that reached the middle stroma. No adverse effects were observed. CONCLUSIONS: Argon laser phototherapy is useful as an adjunctive treatment of refractory fungal keratitis. More cases are needed to validate our findings.

Treatment of fungal keratitis from Fusarium infection by corneal cross-linking.

PURPOSE: To evaluate the efficacy of corneal cross-linking (CXL) (riboflavin-UV-A) as a simple therapy in Fusarium keratitis. METHODS: Twenty-four rabbits were systemically anesthetized, and the stromata of their right corneas were inoculated with Fusarium solani [10(5) colony-forming units (CFU) per milliliter]. Rabbits were divided into 2 groups: one was treated with CXL 72 hours after infection and the other did not receive any treatment (control). All eyes in both the groups were examined before (days 0 and 3) and after (day 7) CXL treatment. The eyes were enucleated, and corneal buttons were sent for microbiological and histological examinations. RESULTS: All animals developed Fusarium keratitis; there was no statistically significant difference between groups before treatment (day 0, P = 0.397 and day 3, P = 0.702). After CXL treatment, the difference in clinical scores on day 7 between groups was statistically significant (P = 0.00); the CXL group showed significant lower clinical score. The CXL group had 22.45 ± 5.09 CFU/g compared with 42.5 ± 3.12 CFU/g in the control group; this difference was statistically significant (P = 0.01). In the 3 buttons of the control group, similar amounts of Fusarium hyphae and inflammatory cells were observed. In 2 of the 3 buttons analyzed from the CXL group, fewer Fusarium hyphae, inflammatory cells, and nonspecific stromal changes were observed compared with the control group. CONCLUSIONS: Treatment of fungal keratitis with CXL seems to be effective in decreasing the intensity and severity of infectious keratitis by F. solani. This therapy may be useful as a coadjuvant in the medical treatment of resistant infections.

Recurrent endogenous Candida.

We report a 61-year-old who developed candidemia following pancreatic tumor surgery, and presented with bilateral multifocal chorioretinitis and vitritis. Chorioretinal lesions regressed with fluconazole therapy. Pars plana vitrectomy was performed with resultant improved visual acuity, but vitritis recurred with the next chemotherapy session. With the cessation of chemotherapy, vitritis regressed without any systemic treatment.