Atlas of Ophthalmology

Contact Lens-associated Fungal Keratitis (Colour Images, Time Course)

Cornea -> Keratitis, Infectious/ Non-Infectious
Colour images showing the time course of stromal infiltrates before and during local therapie with voriconazole. 19 years of age, male contact lenses wearer with sudden decrease of vision at OS. He presented with keratitis at OS. Conjunctival swab was sterile. Microbiological examination of the contact lens liquids identified Aspergillus flavus and Candida pulverina. Within 2 weeks of local therapy with voriconazole the area of the stromal infiltrate decreased. In general fungal keratitis represents one of the most difficult forms of microbial keratitis to diagnose and treat successfully. It is difficult to obtain correct diagnosis and topical antifungal preparations. Fungi can cause severe stromal necrosis and enter the anterior chamber by penetrating an intact Descemet membrane. The most common pathogens are filamentous fungi (Aspergillus and Fusarium spp.) and Candida albicans. Aspergillus species are aggressive corneal pathogens, and even with proper treatment, can lead to poor outcomes. Voriconazole is effective against Aspergillus species. In a study (1) corneal isolates were tested for susceptibility to 6 antifungal agents: amphotericin B, natamycin, caspofungin acetate, itraconazole, voriconazole, and posaconazole. Susceptibility was determined. The triazoles performed best against Aspergillus species, with posaconazole having significantly lower MICs than the second most effective agent, voriconazole. Literature: (1) Lalitha P, Shapiro BL, Srinivasan M, Prajna NV, Acharya NR, Fothergill AW, Ruiz J, Chidambaram JD, Maxey KJ, Hong KC, McLeod SD, Lietman TM. Antimicrobial susceptibility of Fusarium, Aspergillus, and other filamentous fungi isolated from keratitis. Arch Ophthalmol. 2007 Jun;125(6):789-93.

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