Top

Journal of Ophthalmic Inflammation and Infection

Published in:

Open Access 01-12-2016 | Brief report

Alternaria keratitis after uneventful phacoemulsification in an otherwise healthy adult

Authors: Sana Khochtali, Amir Hriz, Fatma Abid, Imen Khairallah-Ksiaa, Bechir Jelliti, Moncef Khairallah

Published in: Journal of Ophthalmic Inflammation and Infection | Issue 1/2016

Abstract

Background

Fungal infections of self-sealing corneal incisions in cataract surgery are scarce. We report a case of Alternaria keratitis, several weeks after uneventful clear-cornea phacoemulsification.

Findings

A 42-year-old woman, with a history of retinitis pigmentosa, complained of painful red right eye, 45 days after uneventful self-sealing clear-cornea phacoemulsification. Slit-lamp examination revealed multiple snow-like contiguous stromal infiltrates, with irregular margins, and no epithelial defect. These infiltrates were unresponsive to topical quinolones and topical corticosteroids as well as oral valaciclovir. Culture from corneal biopsy specimen grew Alternaria species. Management consisted of topical amphotericin-B, and then a combination of topical and oral voriconazole. The corneal infiltrates progressively healed. One year later, the best-corrected visual acuity was 20/400.

Conclusions

Fungal infection, particularly Alternaria keratitis, should be considered in the differential diagnosis of delayed post-cataract surgery keratitis. Prompt diagnosis and management are mandatory to improve visual prognosis.

Kehdi EE, Watson SL, Francis IC, Chong R, Bank A, Coroneo MT, Dart JK (2005) Spectrum of clear corneal incision cataract wound infection. J Cataract Refract Surg 31(9):1702–1706CrossRefPubMed

Garg P, Mahesh S, Bansal AK, Gpinathan U, Rao GN (2003) Fungal infection of sutureless self-sealing incision for cataract surgery. Ophthalmology 110:2173–2177CrossRefPubMed

Espósito E, Maccio JP, Monti R, Cervi L, Serra HM, Urrets-Zavalía JA (2014) Alternaria keratitis and hypopyon after clear-cornea phacoemulsification. J Cataract Refract Surg 40:331–334CrossRefPubMed

Jutley G, Koukkoulli A, Forbes J, Sharma V (2015) Unusual case of Scedosporium apiospermum keratitis following phacoemulsification in a systemically well patient. J Cataract Refract Surg 41(1):230–233CrossRefPubMed

Jhanji V, Sharma N, Mannan R, Titiyal JS, Vajpayee RB (2007) Management of tunnel fungal infection with voriconazole. J Cataract Refract Surg 33(5):915–917CrossRefPubMed

Cosar CB, Cohen EJ, Rapuano CJ, Laibson PR (2001) Clear corneal wound infection after phacoemulsification. Arch Ophthalmol 119(12):1755–1759CrossRefPubMed

Tu EY (2009) Alternaria keratitis: clinical presentation and resolution with topical fluconazole or intrastromal voriconazole and topical caspofungin. Cornea 28:116–119CrossRefPubMed

Cho KJ, Kim MS (2014) Fungal hyphae growing into anterior chamber from cornea. Can J Ophthalmol 49(6):e151–e154CrossRefPubMed

Martone G, Pichierri P, Franceschini R, Moramarco A, Ciompi L, Tosi GM, Balestrazzi A (2011) In vivo confocal microscopy and anterior segment optical coherence tomography in a case of Alternaria keratitis. Cornea 30(4):449–453CrossRefPubMed

10.

Ursea R, Tavares LA, Feng MT, McColgin AZ, Snyder RW, Wolk DM (2010) Non-traumatic Alternaria keratomycosis in a rigid gas-permeable contact lens patient. Br J Ophthalmol 94(3):389–390CrossRefPubMed

11.

Konidaris V, Mersinoglou A, Vyzantiadis TA, Papadopoulou D, Boboridis KG, Ekonomidis P (2013) Corneal transplant infection due to Alternaria alternata: a case report. Case Rep Ophthalmol Med 2013:589620PubMedCentralPubMed

12.

Kocatürk T, Pineda R II, Green LK, Azar DT (2007) Post-LASIK dendritic defect associated with Alternaria. Cornea 26:1144–1146CrossRefPubMed

13.

Tananuvat N, Salakthuantee K, Vanittanakom N, Pongpom M, Ausayakhun S (2012) Prospective comparison between conventional microbial work-up vs PCR in the diagnosis of fungal keratitis. Eye (Lond) 26(10):1337–1343CrossRef

Title: Alternaria keratitis after uneventful phacoemulsification in an otherwise healthy adult
Authors: Sana Khochtali
Amir Hriz
Fatma Abid
Imen Khairallah-Ksiaa
Bechir Jelliti
Moncef Khairallah
Publication date: 01-12-2016
Publisher: Springer Berlin Heidelberg
Published in: Journal of Ophthalmic Inflammation and Infection / Issue 1/2016
Electronic ISSN: 1869-5760
DOI: https://doi.org/10.1186/s12348-016-0072-5

At a glance: The STEP trials

Springer Medicine

Alternaria keratitis after uneventful phacoemulsification in an otherwise healthy adult

Abstract

Background

Findings

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Findings

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2016

Vanishing retinal arterial aneurysms with anti-tubercular treatment in a patient presenting with idiopathic retinal vasculitis, aneurysms, and neuroretinitis

Acute Borrelia infection inducing an APMPPE-like picture

Candida albicans scleral abscess in a HIV-positive patient and its successful resolution with antifungal therapy—a first case report

Post-clear corneal phacoemulsification endophthalmitis: profile and management outcomes at a tertiary eye care center in western India

Bilateral multiple choroidal granulomas and systemic vasculitis as presenting features of tuberculosis in an immunocompetent patient

Reply to “Early resolution of subretinal fluid without high-dose corticosteroids in a pregnant patient with Vogt-Koyanagi Harada disease” by Sugita et al.