Department of Vitreoretinal Surgery, Medical University, Lublin, Poland.
Ann Agric Environ Med. 2021 Sep 16;28(3):409-413. doi: 10.26444/aaem/128682. Epub 2020 Nov 23.
With the rising number of contact lens users, there has been observed an increasing number of patients admitted to ophthalmology wards with severe keratitis, including those of fungal etiology. One of the most devastating specimens is Fusarium spp. If not diagnosed and treated from the onset of the symptoms, it can lead to severe visual loss, or even blindness.
This a retrospective case report of a 36-year-old pregnant female diagnosed with Fusarium keratitis, not responding to topical treatment. The problem is discussed and includes the most relevant literature review.
Primary therapeutic keratoplasty is prone to failure due to an ongoing inflammation process in the eye, as happened in the described patient. Spread of the infection to the vitreous body necessitated the procedure of penetrating keratoplasty with lens removal, pars plana vitrectomy and silicone oil. After treatment, the inflammation resolved, and best corrected visual acuity at the 6 months follow-up was 0.5 (Snellen charts).
There is currently no treatment for Fusarium keratitis that would offer similar results to those observed in bacterial infection treated early with antibiotics. As systemic therapy with antifungal agents is not an option in pregnant women, they are even more of a challenge. Diagnosis is quite often delayed, leading to deeper infiltration of the cornea, sometimes with vitreous involvement. For such cases, a combined approach is proposed with vitrectomy, lens removal and penetrating keratoplasty. Early surgical intervention may rescue some of the eyes non-responsive to topical and systemic treatment.
随着隐形眼镜使用者的增加，越来越多的角膜炎患者，包括真菌性病因，被收入眼科病房。其中最具破坏性的病原体之一是镰刀菌属。如果不及时诊断和治疗，它可能导致严重的视力丧失，甚至失明。
这是一例 36 岁孕妇患镰刀菌角膜炎的回顾性病例报告，该患者对局部治疗无反应。对该病例进行了讨论，并包括了最相关的文献复习。
由于眼部持续存在炎症过程，原发性治疗性角膜移植术容易失败，正如所描述的患者那样。感染向玻璃体扩散，需要进行穿透性角膜移植术、晶状体切除术、玻璃体切除术和硅油填充。经过治疗，炎症得到缓解，6 个月随访时最佳矫正视力为 0.5（Snellen 图表）。
目前，镰刀菌角膜炎的治疗方法无法达到与早期用抗生素治疗细菌性感染相同的效果。由于系统性抗真菌治疗在孕妇中不可行，因此治疗更为困难。诊断往往被延误，导致角膜深层浸润，有时伴有玻璃体受累。对于此类病例，建议采用玻璃体切除术、晶状体切除术和穿透性角膜移植术联合治疗。早期手术干预可能挽救一些对局部和全身治疗无反应的眼睛。
