Successful treatment of anterior chamber infection after penetrating keratoplasty.

PURPOSE

To report the successful management of an anterior chamber (AC) infection after penetrating keratoplasty (PK) caused by .

OBSERVATION

A 53-year-old female had a PK in her right eye. The donor rim tested positive for one week later. Despite initiation of prophylactic topical 1% voriconazole drops, the patient presented with a white mass in the anterior chamber one month later. Biopsy confirmed . Antifungal therapy was intensified with the addition of intravenous fluconazole, and with repeated irrigations of the AC and intracameral administration of amphotericin B (off-label use). After two weeks of apparent lack of treatment response, the infection suddenly quiesced. The final outcome was visual acuity of 0.2 and a clear graft with an endothelial cell density of 2260 cells/mm. .

CONCLUSIONS AND IMPORTANCE

Fungal intraocular infections after PK are usually devastating. Due to low intraocular penetration of topical antifungals, serial intracameral injections were used to maintain a therapeutic concentration of amphotericin B within the anterior chamber, and intravenous fluconazole was administered to protect against the spread of infection into the vitreous. A clinical response developed after two weeks. The reported case represents a favorable outcome using a multimodal approach.