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Kim and Chang: A Case of Fungal Keratitis after Intracorneal Ring Segment Implantation for Keratoconus
Case Report
Journal of the Korean Ophthalmological Society

Journal of the Korean Ophthalmological Society 2012; 53(6): 866-871.

Published online: 16 June 2012

DOI: https://doi.org/10.3341/jkos.2012.53.6.866

A Case of Fungal Keratitis after Intracorneal Ring Segment Implantation for Keratoconus

Si Bum Kim, MD, Moo Hwan Chang, MD, PhD

Department of Ophthalmology, Dankook University Medical College, Cheonan, Korea.

Address reprint requests to Moo Hwan Chang, MD, PhD. Department of Ophthalmology, Dankook University Hospital, #201 Manghyang-ro, Dongnam-gu, Cheonan 330-715, Korea. Tel: 82-41-550-6377, Fax: 82-41-561-0137, changmh@dankook.ac.kr

Received 13 May 2011       Accepted 29 April 2012

Copyright © 2012 The Korean Ophthalmological Society

Abstract

Purpose

To report a case of fungal keratitis 3 days after intracorneal ring segment (ICRS) implantation for keratoconus.

Case summary

A 65-year-old woman was referred to our clinic with refractory infectious keratitis in her left eye 3 days after ICRS insertion for keratoconus. Slit lamp examinations revealed infiltrates around the incision site with cellular reaction in the anterior chamber after the ICRS had been removed. Corneal scrapings were obtained for staining and cultures, and intensive topical antibiotics were administered. Initial microscopy and cultures were negative. Despite the use of intensive topical antibiotics, there was no improvement. Hyphae were isolated from additional corneal scrapings. The patient's symptoms and corneal findings improved following administration of topical amphotericin B and oral itraconazole.

Conclusions

Infectious keratitis after ICRS implantation is an uncommon but sight-threatening complication. Fungal keratitis should also be considered if infectious keratitis after ICRS is unresponsive to antibiotics.

Keywords: Intracorneal ring segment, Kerarings, Keratoconus

Figures and Tables

Figure 1
(A, B) At the initial visit, slit-lamp examination revealed dense, white stromal infiltrates and epithelial defects in the temporal paracentral cornea with ciliary injection and chemosis. (C, D) After 3 days, stromal infiltration and the epithelial defects increased.
jkos-53-866-g001
Figure 2
(A) Epithelial bullae (white arrow) around the stromal lesion 1 week after 0.3% Amphotericin B treatment. (B) Note complete resolution of the bullae by week 1 without any other treatment.
jkos-53-866-g002
Figure 3
Photographs of the left eye just before the patient was discharged. There were paracentral corneal opacities and stromal thinning without epithelial defects.
jkos-53-866-g003
Table 1
Infectious keratitis related to intracorneal ring segment implantation (ICRS)
jkos-53-866-i001

N/S = not specified; S. aureus = Staphylococcus aureus; S. pneumoniae = Streptococcus pneumonia; sp. = species; S. viridans = Streptococcus viridians; PKP = penetrating keratoplasty; S. epidermidis = Straphycoccus epidermidis.

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