CORNEAL CHROMOBLASTOMYCOSIS

Purpose. We sought to illustrate the difficulty in managing uncommon, pigmented mold-related corneal ulceration and to highlight the role of itraconazole in treating these patients. Method, We describe the mana gement and clinical course of a patient with a recurring corneal infec tion caused by Fonsecaea pedrosoi and discuss this experience in the l ight of existing literature on management of cutaneous chromoblastomyc osis. Results, A corneal ulcer caused by this organism healed initiall y on treatment with topical and systemic antifungal medication, but in fection recurred in the deep stroma 4 months after cessation of therap y. After failure to respond to a further period of medical therapy, a small therapeutic penetrating keratoplasty was performed. Culture of a fibrinous membrane from the anterior iris surface demonstrated intrao cular fungal infection, and postoperatively, an episode of marked fibr inous uveitis developed, suggesting the presence of viable intraocular fungal elements. A large penetrating keratoplasty was therefore perfo rmed with excision of involved iris in combination with extracapsular cataract extraction. F. pedrosoi was again cultured from the fibrinous membrane adherent to the iris and from the anterior lens capsule. Pos toperatively the patient received a 5-month course of systemic itracon azole, and no further recurrences have been encountered after a furthe r 2 months. Conclusion, F. pedrosoi is the organism most commonly isol ated from the chronic cutaneous mycosis, chromoblastomycosis, and is r elatively resistant to medical therapy. As has been reported for cutan eous disease, surgery in combination with systemic itraconazole may pr ovide the best chance of cure in corneal chromoblastomycosis.