Şahin Seray, Hilmioglu Polat Süleyha, Barut Selver Özlem
From the Department of Ophthalmology, Ege University, İzmir, Turkey.
Exp Clin Transplant. 2025 Mar;23(3):235-238. doi: 10.6002/ect.2024.0122.
Here, we present the successful sclerokeratoplasty surgery in resistant Scedosporium (Pseudallescheria) boydii keratitis. A 47-year-old male patient presented with complaints of 4-mm corneal infiltration and 1-mm hypopyon after an eye injury with organic material. Topical treatments with vancomycin (50 mg/mL), ceftazidime (50 mg/mL), voriconazole (10 mg/mL), and amphotericin B (0.5 mg/mL) were started hourly. Because of the significant progression despite the treatment, emergency therapeutic penetrating keratoplasty was performed. In this patient, in whom Scedosporium boydii growth was detected in mycological examination, although the infection appeared under control after keratoplasty, recurrence occurred on day 30. Hence, because of the rapid progression of the infection to the corneoscleral junction despite intensive treatment, emergency sclerocorneal transplant was performed. Globe integrity was preserved, and the patient had no recurrence in the 5-month follow-up. In severe S. boydii keratitis that causes infiltration up to the limbus border, removal of infected corneal tissue by wide excision and sclerocorneal transplant along with medical treatment may offer a successful treatment option. To the best of our knowledge, this is the first case in which sclerokeratoplasty was performed to successfully treat S. boydii keratitis.
在此，我们展示了在难治性波氏假阿利什霉角膜炎中成功进行的巩膜角膜移植手术。一名47岁男性患者在眼部被有机物质损伤后，出现了4毫米的角膜浸润和1毫米的前房积脓。开始每小时使用万古霉素（50毫克/毫升）、头孢他啶（50毫克/毫升）、伏立康唑（10毫克/毫升）和两性霉素B（0.5毫克/毫升）进行局部治疗。尽管进行了治疗，但病情仍显著进展，遂进行了急诊治疗性穿透性角膜移植术。在该患者的真菌学检查中检测到波氏假阿利什霉生长，尽管角膜移植术后感染似乎得到控制，但在第30天复发。因此，由于尽管强化治疗但感染仍迅速蔓延至角膜巩膜交界处，遂进行了急诊巩膜角膜移植术。眼球完整性得以保留，患者在5个月的随访中未出现复发。在导致浸润直至角膜缘边界的严重波氏假阿利什霉角膜炎中，通过广泛切除去除感染的角膜组织并进行巩膜角膜移植术，同时结合药物治疗，可能提供一种成功的治疗选择。据我们所知，这是首例通过巩膜角膜移植术成功治疗波氏假阿利什霉角膜炎的病例。
