Fonsecaea Fungal Keratitis after Radial Keratotomy-A Case Report

放射狀角膜切開術後罕見之著色真菌感染－病例報告

羅伍娉(Wu-Ping Lo) ； 郭晉良(Ching-Liang Kuo) ； 郭明澤(Ming-Tse Kuo) ； 方博炯(Po-Chiung Fang)

《中華民國眼科醫學會雜誌》 48卷2期 (2009/06) Pp. 195-199

https://doi.org/10.30048/ACTASOS.200906.0012

摘要

目的：報告一例放射狀角膜切開術後，感染罕見的著色真菌，病發至治癒之經過。
方法：病例報告。
結果：一24歲女性，於放射狀角膜切開手術術後兩週，左眼疼痛角膜潰瘍，經廣效性局部抗生素初步治療無效並惡化，病原培養顯示為一罕見著色真菌感染，改採用抗黴菌藥物併進行治療性角膜移植以控制感染，感染受到控制後再施以清澈的角膜移植，使病人在經歷嚴重地角膜感染之後，仍能保持最佳矯正視力20/40。
結論：放射狀角膜切開術術後後，若發生難以控制的角膜潰瘍，要考慮其遭受罕見真菌感染的可能性，而早期正確的病原培養可以幫助我們給予病人合適的藥物治療，病患角膜雖感染程度嚴重，但加以積極手術治療仍有可以保存可用視力的機會。

並列摘要

Purpose: To report a case of ulcerative keratitis caused by Fonsecaea sp. after radial keratotomy.
Method: Case report.
Result: A 24 year-old female developed left eye pain two weeks after radial keratotomy. She was transferred to our hospital due to progressive pain despite of topical antibiotics treatment. The slitlamp biomicroscopic examination revealed a 5mm ring shape infiltrate up to 1/2 corneal depth with surrounding corneal edema. Initial smear from scrapping specimen did not show any pathogen. The culture revealed Fonsecaea sp. a chromoblastomycosis. The infiltrate progressed along the RK wound and intractable ocular pain developed even under the antifungal treatment with topical Amphotericin B and oral Ketoconazole. Therapeutic penetrating keratoplasty with glycerol preserved cornea was performed 3 weeks after initial presentation. The infection was controlled and pain was relieved postoperatively. Fungal hyphae was identified on GMS and PAS stains of corneal button. She received an optical PK 6 months later with clear graft and corrected vision 20/40 till now.
Conclusion: Fonsecaea sp. fungal ulcerative keratitis may occur after RK.
Accurate diagnosis with proper medication and surgical intervention can cure the infection with favorable visual outcome.

並列關鍵字

Fonsecaea ； Fungal keratitis ； Radial keratotomy