Klinische Monatsblatter fur Augenheilkunde · 2018
[Therapy Resistant Fusarium Keratitis with Intraocular Involvement - Potential Sources of a Persisting Infection].
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Löffler Karin U, Holz Frank G, Herwig-Carl Martina C
Аннотация
BACKGROUND: Fungal keratitis shows a variable clinical picture and is therefore often diagnosed only late. Fungi in general are quite resistant organisms, and in addition treatment is difficult due to limited and specially manufactured medications.
MATERIAL AND METHODS/RESULTS: We describe the unfavourable outcome in a young female patient with keratitis due to fusarium that ended - despite extensive medical and surgical treatment - in enucleation. Histologic examnination of the enucleated globe revealed massive (post-)inflammatory changes throughout the anterior segment but only few persistent fungal elements that were found in the lens capsule (after phacoemulsification) and the peripheral Descemet's membrane.
CONCLUSION: Fungus as the pathogenic agent in therapy-resistent keratitis should be included in the differential diagnosis as early as possible. Should surgical interventions become necessary, a keratoplasty as large as possible and removal of the lens capsule should be considered in order to eliminate potential reservoirs for the causative organism.
MATERIAL AND METHODS/RESULTS: We describe the unfavourable outcome in a young female patient with keratitis due to fusarium that ended - despite extensive medical and surgical treatment - in enucleation. Histologic examnination of the enucleated globe revealed massive (post-)inflammatory changes throughout the anterior segment but only few persistent fungal elements that were found in the lens capsule (after phacoemulsification) and the peripheral Descemet's membrane.
CONCLUSION: Fungus as the pathogenic agent in therapy-resistent keratitis should be included in the differential diagnosis as early as possible. Should surgical interventions become necessary, a keratoplasty as large as possible and removal of the lens capsule should be considered in order to eliminate potential reservoirs for the causative organism.