J Korean Ophthalmol Soc.  2016 Mar;57(3):390-398. 10.3341/jkos.2016.57.3.390.

Paecilomyces Keratitis: Cases in Korea and Literature Review

• Chung SR
• You IC
• Cho NC
• Ahn M

• KMID: 2213239
• DOI: http://doi.org/10.3341/jkos.2016.57.3.390

Abstract

PURPOSE
To analyze the Paecilomyces keratitis cases in Korea and compare cases from foreign literature.
METHODS
The records of 3 patients diagnosed with Paecilomyces keratitis at our hospital and other reported cases in Korea were evaluated to examine the predisposing factors, clinical aspects, antifungal therapy, therapeutic surgery, and visual outcome and compared with previously reported foreign cases.
RESULTS
In Korea, 1 patient was female, 4 patients were male and had predisposing factors including prior corneal trauma or surgery, except 1 spontaneous occurrence. All 5 eyes of 5 patients had poor initial visual acuity, less than finger count, and deep corneal infiltration. The patients were treated with multiple topical and systemic antifungal treatments such as intracameral or intrastromal voriconazole injections and required evisceration and penetrating keratoplasty. However, the final outcomes were unsatisfactory. Previously reported cases from foreign literature also had predisposing factors such as corneal surgery, trauma, and soft contact lens use. They were resistant to antifungal therapy and eventually led to surgeries such as penetrating keratoplasty and the final outcomes were poor.
CONCLUSIONS
Frequently, Paecilomyces keratitis has direct risk factors and is resistant to many topical and systemic antifungal agents. In the majority of cases, therapeutic surgery was required and the final visual outcomes were poor. When Paecilomyces keratitis is suspected, we suggest aggressive therapy including intracameral and intravitreal injections of voriconazole in the initial treatment.

Keyword

Corneal ulcer; Fungal keratitis; Paecilomyces; Voriconazole

MeSH Terms

Antifungal Agents
Causality
Contact Lenses, Hydrophilic
Corneal Ulcer
Female
Fingers
Humans
Intravitreal Injections
Keratitis*
Keratoplasty, Penetrating
Korea*
Male
Paecilomyces*
Risk Factors
Visual Acuity
Antifungal Agents

Figure

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  Figure 1. Slit-lamp photographs of Case 1. (A) At the initial visit, 4.5 × 4.5 mm sized epithelial defect with a 1.2 mm height hypopyon. (B) After 3 months, corneal lesion regressed with opacity at corneal center.

• 

  Figure 2. Slit-lamp photographs of Case 2. (A) At the initial visit, 6.0 × 7.0 mm sized epithelial defect with a 1.5 mm height hypopyon. (B) After 2 weeks, epithelial defect was healed with corneal opacity at the center and the infected eye became phthisis bulbi.

• 

  Figure 3. Slit-lamp photographs of Case 3. (A) At the initial visit, 8.0 × 7.0 mm sized epithelial defect with satellite lesion at the superior. (B) The patient rejected antifungal treatment and returned to hospital with corneal perforation.

Reference

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