Fonsecaea Fungal Keratitis after Radial Keratotomy-A Case Report

Abstract

Purpose: To report a case of ulcerative keratitis caused by Fonsecaea sp. after radial keratotomy. Method: Case report. Result: A 24 year-old female developed left eye pain two weeks after radial keratotomy. She was transferred to our hospital due to progressive pain despite of topical antibiotics treatment. The slitlamp biomicroscopic examination revealed a 5mm ring shape infiltrate up to 1/2 corneal depth with surrounding corneal edema. Initial smear from scrapping specimen did not show any pathogen. The culture revealed Fonsecaea sp. a chromoblastomycosis. The infiltrate progressed along the RK wound and intractable ocular pain developed even under the antifungal treatment with topical Amphotericin B and oral Ketoconazole. Therapeutic penetrating keratoplasty with glycerol preserved cornea was performed 3 weeks after initial presentation. The infection was controlled and pain was relieved postoperatively. Fungal hyphae was identified on GMS and PAS stains of corneal button. She received an optical PK 6 months later with clear graft and corrected vision 20/40 till now. Conclusion: Fonsecaea sp. fungal ulcerative keratitis may occur after RK. Accurate diagnosis with proper medication and surgical intervention can cure the infection with favorable visual outcome.