Wilde Craig, Messina Marco, Moshiri Tara, Snape Susan E, Maharajan Senthil
Ophthalmology and Vision Sciences, Division of Clinical Neurosciences, B Floor, EENT Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK.
Microbiology department, Queen's Medical Centre, Derby Road, Nottingham, NG7 2UH, UK.
Int Ophthalmol. 2018 Oct;38(5):2211-2217. doi: 10.1007/s10792-017-0706-0. Epub 2017 Sep 12.
To report for the first time a case of interface Scopulariopsis gracilis fungal keratitis following Descemet's stripping automated endothelial keratoplasty (DSAEK) with a contaminated graft.
A 57-year-old man with bilateral keratoconus and previous bilateral penetrating keratoplasties (PK) developed graft failure in association with marked corneal ectasia. He underwent a successful DSAEK. Unfortunately, a contaminated graft was transplanted and the following morning we were contacted by the eye bank to inform us a slow-growing fungus had been detected in the culture plates inoculated with dextran solution used to store the issued corneoscleral button. Immediate patient review revealed four infiltrates in the interface between the donor and the recipient tissue. The patient returned to theatre for the removal of the infected graft and was successfully treated with topical amphotericin 0.15%, voriconazole 1% and oral voriconazole and later oral itraconazole. Two intracameral injections of 5 µg in 0.1 ml of amphotericin B were also performed.
A reference laboratory cultured and identified the fungus as Scopulariopsis gracilis species. The patient responded to treatment and eventually achieved a spectacle-corrected logMAR visual acuity of 0.3 following a delayed PK.
Scopulariopsis gracilis fungal keratitis is a rare infection, and the species can be difficult to eradicate. This is the first case report of an infection secondary to a contaminated graft with the species, and we report its successful treatment with an excellent visual outcome.
首次报告1例在使用受污染移植物的Descemet膜剥离自动内皮角膜移植术（DSAEK）后发生的纤细帚霉性界面真菌性角膜炎病例。
一名57岁男性，患有双侧圆锥角膜且既往有双侧穿透性角膜移植术（PK），因明显的角膜扩张出现移植失败。他接受了一次成功的DSAEK。不幸的是，移植了一个受污染的移植物，第二天早上眼库联系我们，告知我们在接种用于储存发放的角膜巩膜钮的右旋糖酐溶液的培养板中检测到一种生长缓慢的真菌。对患者进行立即检查发现供体和受体组织界面有四处浸润。患者返回手术室取出受感染的移植物，并成功接受了0.15%的局部两性霉素、1%的伏立康唑和口服伏立康唑治疗，后来又接受了口服伊曲康唑治疗。还进行了两次前房内注射，每次在0.1 ml中注射5 μg两性霉素B。
一个参考实验室培养并鉴定该真菌为纤细帚霉种。患者对治疗有反应，最终在延迟PK后获得了矫正视力为0.3的logMAR视力。
纤细帚霉性真菌性角膜炎是一种罕见的感染，该菌种可能难以根除。这是首例因该菌种污染移植物继发感染的病例报告，我们报告了其成功治疗及良好的视力预后。
