J Korean Ophthalmol Soc.  2017 Oct;58(10):1194-1198. 10.3341/jkos.2017.58.10.1194.

Cryotherapy on Refractory Fungal Corneal Ulcer: A Case Report

• Kim HJ
• Lim HR
• Koh JW

• KMID: 2393173
• DOI: http://doi.org/10.3341/jkos.2017.58.10.1194

Abstract

PURPOSE
We report a case of cryotherapy for fungal corneal ulcers that did not respond to antifungal agents.
CASE SUMMARY
A 58-year-old man was transferred to our hospital with a left eye corneal ulcer due to pain and visual impairment in his left eye for two weeks, and he was suspected to have a history of fungal infection. At the time of admission, corneal opacity and progressive ulcerative lesions were observed at 5 o'clock in the left eye and visual acuity was 0.025, uncorrected. The corneal ulcer marginal resection, bacterial culture, and potassium hydroxide preparation (KOH) test were performed on lesion sites. Cultures of Candida albicans were reported to grow, topical antibiotics (Fortified tobramycin, Fortified cefazolin, moxifloxacin), and anti-fungal agents (fortified amphotericin B, 0.5%, Natamycin) were administered, but no improvement was observed for 2 weeks. On the 14th day after admission, Cryotherapy was performed. After surgery, eye drops were equally applied, and there was no other discomfort other than pain for 3 days after the operation. He discharged 10 days after surgery, the corneal lesion was healed and the visual acuity was improved to 0.32, uncorrected.
CONCLUSIONS
We report a case of cryotherapy for fungal corneal ulcers that did not react with topical antifungal drugs and improved visual acuity and symptom improvement.

Keyword

Cryotherapy; Refractive fungal cornea ulcer

MeSH Terms

Amphotericin B
Anti-Bacterial Agents
Antifungal Agents
Candida albicans
Cefazolin
Corneal Opacity
Corneal Ulcer*
Cryotherapy*
Humans
Middle Aged
Ophthalmic Solutions
Potassium
Tobramycin
Ulcer
Vision Disorders
Visual Acuity
Amphotericin B
Anti-Bacterial Agents
Antifungal Agents
Cefazolin
Ophthalmic Solutions
Potassium
Tobramycin

Figure

• 

  Figure 1 Anterior segment photo of the patient who did not show improvement in medical treatment for 2 weeks. 2 weeks after medical treatment, (A) corneal opacity and progressive infiltrative lesion still observed at 5 o'clock in the left eye. (B) Cornea epithelial defect with ulcerative lesion observed in the cornea at 5 o'clock after stining.

• 

  Figure 2 Photo of cryotherapy. Cryotherapy was performed on 5 o'clock of progressive ulcerative and infiltrative lesion refractory to previous medical treatment.

• 

  Figure 3 2 months after cryotherapy. (A) Corneal neovascularization and corneal opacity remain, since 5 o'clock cornea lesion completely healed. (B) Corneal epithelium defect was fully recovered.

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