Soda Rina, Fukuoka Hideki, Sotozono Chie
Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Department of Ophthalmology, Kyoto City Hospital, Kyoto, Japan.
Case Rep Ophthalmol. 2022 Mar 17;13(1):147-153. doi: 10.1159/000522369. eCollection 2022 Jan-Apr.
Here, we report a rare case of recurrent fungal keratitis (FK) post-amniotic membrane transplantation (AMT) for corneal perforation. A 75-year-old female who had undergone systemic 15 mg prednisolone administration for interstitial pneumonia developed FK in her left eye following treatment for herpetic epithelial keratitis at another clinic. The FK was effectively cured via an oral and local antifungal treatment. However, 1 year later, FK recurred in her left eye, and she was subsequently referred to our hospital since fungal infection had penetrated deep into the cornea. Upon examination, her best-corrected visual acuity was 20/20 OD and hand motion OS. Slit-lamp examination revealed infiltration of corneal ulcers and posterior corneal deposits in her left eye, so she was treated with 0.1% miconazole eye drops in addition to oral miconazole and 1% pimaricin ointment. However, corneal perforation occurred 1 week later, so debridement and AMT were performed, which resulted in a successful outcome. At the 4-month postoperative period, the antifungal eye-drop treatment was discontinued due to no clinical signs of infection with scar formation. However, at the 6-month postoperative period, increased white deposits and the emergence of keratic precipitates were observed around the AMT graft. Recurrent FK was suspected, and anterior-chamber irrigation was performed. Immunostaining revealed a yeast-type fungus, and a cultivation test revealed sp. Thus, penetrating keratoplasty was performed, and there has been no recurrence of FK for 1.5 years. In FK cases, AMT should be carefully considered for surgical indications, with strict follow-up in order to detect any possibility of FK recurrence.
在此，我们报告一例罕见的复发性真菌性角膜炎（FK）病例，该病例发生在羊膜移植（AMT）治疗角膜穿孔之后。一名75岁女性因间质性肺炎接受了全身性15毫克泼尼松龙治疗，在另一家诊所治疗疱疹性上皮性角膜炎后，左眼发生了FK。通过口服和局部抗真菌治疗，FK得到了有效治愈。然而，1年后，她的左眼FK复发，由于真菌感染已深入角膜，她随后被转诊至我院。检查时，她的最佳矫正视力右眼为20/20，左眼为手动。裂隙灯检查发现她左眼有角膜溃疡浸润和角膜后沉着物，因此除口服咪康唑和1%匹马霉素眼膏外，还使用0.1%咪康唑滴眼液对她进行治疗。然而，1周后发生了角膜穿孔，于是进行了清创和AMT，结果成功。术后4个月，由于没有感染的临床迹象且有瘢痕形成，停止了抗真菌滴眼液治疗。然而，在术后6个月时，在AMT移植物周围观察到白色沉积物增加和角膜后沉着物出现。怀疑复发性FK，于是进行了前房冲洗。免疫染色显示为酵母型真菌，培养试验显示为 菌。因此，进行了穿透性角膜移植术，1.5年来FK未再复发。在FK病例中，对于手术指征应谨慎考虑AMT，并进行严格随访，以检测FK复发的任何可能性。
