Successful treatment of Candida albicans anterior chamber infection after penetrating keratoplasty

Štunf, Špela (author), Herceg, Azra (author), Globočnik Petrovič, Mojca (author), Pfeifer, Vladimir (author)

Purpose: To report the successful management of an anterior chamber (AC) infection after penetrating keratoplasty (PK) caused by Candida albicans. Observation: A 53-year-old female had a PK in her right eye. The donor rim tested positive for Candida albicans one week later. Despite initiation of prophylactic topical 1% voriconazole drops, the patient presented with a white mass in the anterior chamber one month later. Biopsy confirmed Candida. Antifungal therapy was intensified with the addition of intravenous fluconazole, and with repeated irrigations of the AC and intracameral administration of amphotericin B (off-label use). After two weeks of apparent lack of treatment response, the infection suddenly quiesced. The final outcome was visual acuity of 0.2 and a clear graft with an endothelial cell density of 2260 cells/mm. 2 Conclusions and Importance: Fungal intraocular infections after PK are usually devastating. Due to low intraocular penetration of topical antifungals, serial intracameral injections were used to maintain a therapeutic concentration of amphotericin B within the anterior chamber, and intravenous fluconazole was administered to protect against the spread of infection into the vitreous. A clinical response developed after two weeks. The reported case represents a favorable outcome using a multimodal approach.

• Language: English
• Keywords: penetrating keratoplasty, fungal infection, intracameral amphotericin, antifungal therapy, donor rim cultures
• Work type: Article
• Typology: 1.03 - Other scientific articles
• Organization: MF - Faculty of Medicine
• Publication status: Published
• Publication version: Version of Record
• Year: 2022
• Number of pages: 4 str.
• Numbering: Vol. 26, art. 101466
• PID: 20.500.12556/RUL-139084
• UDC: 617.7
• ISSN on article: 2451-9936
• DOI: 10.1016/j.ajoc.2022.101466
• COBISS.SI-ID: 109430019
• Publication date in RUL: 30.08.2022

Record is a part of a journal

• Title: American journal of ophthalmology. Case reports
• Publisher: Elsevier
• ISSN: 2451-9936
• COBISS.SI-ID: 526353433

Licences

• License: CC BY-NC-ND 4.0, Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
• Link: http://creativecommons.org/licenses/by-nc-nd/4.0/
• Description: The most restrictive Creative Commons license. This only allows people to download and share the work for no commercial gain and for no other purposes.

Secondary language

• Language: Slovenian
• Keywords: očesne bolezni, keratoplastika, glivične okužbe, roženica