CC BY-NC-ND 4.0 · Journal of Health and Allied Sciences NU 2016; 06(02): 088-090
DOI: 10.1055/s-0040-1708651
Case Report

Unusual Presentation of Fungal Keratitis- Anterior Chamber Granuloma with Necrotising Scleritis: A Case Report

Soumya Haridasan
1   Postgraduate, Department of Ophthalmology, K. S. Hegde Medical Academy, Nitte University, Mangalore, Karnataka, India
,
Vijay Pai
2   Professor and HOD, Department of Ophthalmology, K. S. Hegde Medical Academy, Nitte University, Mangalore, Karnataka, India
› Author Affiliations

Abstract

This is a rare case of fungal keratitis presenting as anterior chamber granuloma with necrotising scleritis where a 56 year old woman presented with pain, redness, watering, discharge and blurring of vision in right eye for 6 months and on examination was found to have granulomatous exudate with hypopyon in anterior chamber and staphyloma. On treatment with Intracameral and intrastromal voriconazole the symptoms subsided within a week. This treatment modality proved to be helpful in preventing the progression of such a blinding disease and improving the vision.



Publication History

Received: 24 December 2015

Accepted: 19 April 2016

Article published online:
22 April 2020

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  • References

  • 1 Haddad SR, El-Mollayess GM. Combination of Intracameral and Intrastromal Voriconazole in the Treatment of Recalcitrant Acremonium Fungal Keratitis. Middle East African Journal of Ophthalmology, 2012; 19(2):265-8.
  • 2 Srinivasan M. Fungal keratitis. Curr Opin Ophthalmol. 2004; 15:321-7.
  • 3 Prajna NV, Krishnan T, Mascarenhas J, et al. The mycotic ulcer treatment trial: a randomized trial comparing natamycin vs voriconazole. JAMA Ophthalmol. 2013; 131:422–429.
  • 4 Mahdy RA, WM Nada, MM Wageh. Topical amphotericin B and subconjunctival injection of fluconazole (combination therapy) versus topical amphotericin B (monotherapy) in treatment of keratomycosis. J Ocul Pharmacol Ther. 2010 jun; 26(3):281-5.
  • 5 Lekhanont K, Nonpassopon M, Nimvorapun N, Santanirand P. Treatment With Intrastromal and Intracameral Voriconazole in 2 Eyes With Lasiodiplodia theobromae Keratitis. Medicine. 2015; 94(6):1-6.
  • 6 Mittal V, Mittal R. Intracameral and Topical Voriconazole for Fungal Corneal Endoexudates. Cornea 2012; 31(4):366–370.
  • 7 Solaiman KA, Alkawas AA, Ibrahim BM, Mahdy MM, Shalaby MA (2015) Topical Voriconazole Drops With and Without Intrastromal Voriconazole Injection for Treatment of Deep or Resistant Fungal Keratitis. J Clin Exp Ophthalmol 6: 469.
  • 8 Shen YC, Wang CY, Tsai HY, Lee HN. Intracameral voriconazole injection in the treatment of fungal endophthalmitis resulting from keratitis. American journal of ophthalmology. 2010 jun; 149(6):916-21.
  • 9 Hariprasad SM, Mieler WF, Lin TK, et al. Voriconazole in the treatment of fungal eye infections: a review of current literature. Br J Ophthalmol. 2008; 92:871–878.
  • 10 Al-Badriyeh D, Neoh CF, Stewart K, et al. Clinical utility of voriconazole eye drops in ophthalmic fungal keratitis. Clin Ophthalmol. 2010; 4:391–405.
  • 11 Chandrasekar PH, Manavathu E. Voriconazole: A second generation triazole. Drugs Today (Barc) 2001; 37:135-48.
  • 12 Sharma N, Chacko J, Velpandian T, et al. Comparative evaluation of topical versus intrastromal voriconazole as an adjunct to natamycin in recalcitrant fungal keratitis. Ophthalmology. 2013; 120:677–681.
  • 13 Prakash G, Sharma N, Goel M, et al. Evaluation of intrastromal injection of voriconazole as a therapeutic adjunctive for the management of deep recalcitrant fungal keratitis. Am J Ophthalmol. 2008; 146:56–59.
  • 14 Sharma N, Agarwal P, Sinha R, et al. Evaluation of intrastromal voriconazole injection in recalcitrant deep fungal keratitis: case series. Br J Ophthalmol. 2011; 95:1735–1737.
  • 15 Kalaiselvi G, Narayana S, Krishnan T, et al. Intrastromal voriconazole for deep recalcitrant fungal keratitis: a case series. Br J Ophthalmol. 2015; 99:195–198.
  • 16 Kernt M, Kampik A. Intracameral voriconazole: In vitro safety for human ocular cells. Toxicology 2009; 258:84-93.