DELAYED-ONSET FUNGAL KERATITIS AFTER ENDOPHTHALMITIS

Purpose: This study aimed to present two patients with delayed-onset, endogenous fungal keratitis after treatment for fungal endophthalmitis after cataract surgery. Methods: The authors retrospectively reviewed the clinical course of two patients in whom deep stromal fungal kerat itis developed 2 weeks and 3 months, respectively, after apparent succ essful aggressive therapy for fungal endophthalmitis. Before the onset of the keratitis, both patients underwent vitrectomies with intraocul ar injection of 7.5 to 10.0 mcg amphotericin B, as well as treatment w ith systemic fluconazole and topical antifungal therapy. In case 1, a pre-existing prosthetic intraocular lens and lens capsular bag were re moved at the time of vitrectomy, whereas in case 2, the intraocular le ns was left in place and a posterior capsulectomy was performed. Resul ts: The keratitis worsened in both patients, despite intensive systemi c and topical antifungal therapy. Both patients underwent therapeutic penetrating keratoplasties. In case 1, this resulted in successful res olution of the infection and no recurrences 3 months after the transpl ant. The corneal transplant was complicated by an expulsive choroidal hemorrhage in the other patient. Fusarium solani was cultured from the initial vitrectomy specimen in patient 1, and although it was not cul tured from the keratitis, septate hyphal elements were present on hist opathologic examination. The causative organism in case 2 was Acremoni um kiliense, which was cultured from both the original vitrectomy spec imen and the deep corneal stromal infiltrate. Conclusions: Fungal orga nisms may not be eradicated completely from eyes with endophthalmitis despite aggressive therapy and apparent initial successful treatment. These patients need to be monitored for prolonged periods, and treatme nt should be reinitiated at the earliest sign of recrudescence of infe ction.