Goel Siddhi, Sharma Arpit, Sinha Rajesh
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
GMS Ophthalmol Cases. 2022 Jul 18;12:Doc19. doi: 10.3205/oc000206. eCollection 2022.
To report a case of recalcitrant fungal keratitis successfully managed with topical caspofungin acetate in North India.
Case report and literature review.
An 18-year-old male patient presented with complaints of redness, watering, pain and diminution of vision in the right eye and was referred to our centre as a case of corneal ulcer. The patient was examined and found to have a near total epithelial defect, with corneal infiltrates approximately 8x8 mm. A provisional diagnosis of polymicrobial keratitis was made based on corneal scraping suggestive of and confocal scan revealing fungal hyphae. The patient failed to respond to topical voriconazole 1%, natamycin 5% and moxifloxacin hydrochloride 0.5% with oral voriconazole. In view of the poor response to these drugs, the patient was subsequently administered topical caspofungin 0.5% in place of natamycin and continued on topical and oral voriconazole, in addition to topical moxifloxacin and cycloplegics, which finally led to healing with minimal scarring. The patient attained a best corrected visual acuity (BCVA) of 6/12.
Topical caspofungin may be used as a useful and effective alternative in cases of recalcitrant fungal keratitis. It may result in healing with minimal scarring.
报告一例在印度北部使用局部醋酸卡泊芬净成功治疗的顽固性真菌性角膜炎病例。
病例报告及文献综述。
一名18岁男性患者因右眼发红、流泪、疼痛及视力下降前来就诊，被转诊至我院诊断为角膜溃疡。经检查，患者角膜上皮几乎完全缺损，角膜浸润约8×8毫米。根据角膜刮片提示及共聚焦扫描发现真菌菌丝，初步诊断为混合性角膜炎。患者对1%伏立康唑滴眼液（局部用药）、5%那他霉素滴眼液（局部用药）、0.5%盐酸莫西沙星滴眼液（局部用药）及口服伏立康唑治疗均无反应。鉴于对这些药物反应不佳，随后该患者改用0.5%醋酸卡泊芬净滴眼液替代那他霉素，并继续使用局部及口服伏立康唑，同时使用局部莫西沙星滴眼液及睫状肌麻痹剂，最终角膜愈合，瘢痕形成最小。患者最佳矫正视力（BCVA）达到6/12。
对于顽固性真菌性角膜炎病例，局部使用醋酸卡泊芬净可能是一种有用且有效的替代治疗方法。它可能使角膜以最小的瘢痕愈合。
