Jornal de Oftalmologia Clínica e Experimental
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Contact-Lens Associated Simultaneous Fusarium and Acanthamoebia Keratitis Treated with Therapeutic Penetrating Keratoplasty

David P S OBrart, FRCOphth and Elizabeth A Gavin

Purpose:To report concurrent Fusarium and Acanthamoeba keratitis associated with contact lens wear and treated with penetrating keratoplasty
 
Methods: A 27 year old woman, presented with a 7 day history of pain, watering and foreign-body sensation in her left eye in the setting of monthly disposable contact lens wear and swimming with lenses in situ. She had been self-treating with combination dexamathasone 0.1% and tobramycin 0.3% drops (Tobradex®). Slit-lamp examination revealed a 1.0 x 1.0 millimetre corneal ulcer with underlying infiltration. Corneal scrapes were performed and hourly Ofloxacillin 0.3% drops commenced. Initially symptoms and signs improved but worsened a week later. The scrapings grew Aspergillus fumigates and she was then referred to the corneal service.
 
Results: At this stage a central stromal infiltrate was observed with surrounding satellite infiltrates. The cornea was re-scraped (as it was felt the Aspergillus culture was the result of a contaminant) and the patient was commenced on hourly Econazole 1% drops and systemic Voriconazole. Three days later, the second scrapings grew Acanthamoeba polyphagia. Intensive Brolene and Polihexamide drops were commenced, in addition to the systemic and topical antifungal treatment. Despite treatment, symptoms and signs of keratitis worsened, vision reduced to light perception and 4 weeks later she underwent a left therapeutic keratectomy. Histological examination of the corneal button revealed fungal hyphae and culture grew Fusarium. Topical anti-protozoal and antifugal therapy and systemic Vorconazole were continued for 8 weeks. Six months following keratoplasty the corneal graft remains clear on a reducing dosage of topical dexamethasone 0.1% with a best corrected visual acuity of 20/30.
 
Conclusion: Concurrent Fusarium and Acanthamoeba keratitis may occur in the setting of contact lens wear and their misuse. Despite intensive appropriate topical and systemic therapy the condition worsened but remained central in location and following therapeutic penetrating keratoplasty resolved.