Keratomycosis is a significant cause of mono-ocular
blindness, especially in tropical regions. Fungal
keratitis developing in corneal incisions is very rare. We report the experience of treating two patients diagnosed with recalcitrant candida
keratitis post-
phacoemulsification with anterior chamber washout and deep
debridement. The first patient was a 68-year-old woman who underwent left eye
phacoemulsification nine months ago with a postoperative best corrected visual acuity of 6/6. The second patient was a 73-year-old man who had uneventful right eye
phacoemulsification six months prior with a postoperative best corrected visual acuity of 6/9. Both patients used topical
steroids postoperatively for more than three months and noted a drop in vision. Both patients had deep stromal infiltration and endothelial plaque at the primary corneal
wound. They were unresponsive to topical, intracameral, and systemic antifungal
therapy. Both patients underwent anterior chamber evacuation of hypopyon and endothelial plaque removal. Evacuation of hypopyon and removal of endothelial plaque was done with a 23G
vitrectomy cutter using a low-powered vacuum controlled at 200 mmHg. The fluid inside the tubing was sent for culture analysis. We used viscoelastic coating on the endothelium to minimize the damage during the operations. Intracameral
amphotericin B 15 µg/0.1 ml was given at the end of the operation. Postoperatively, both patients had clear corneas. The first patient's visual acuity improved 6/18, and the second patient's visual acuity improved to 6/9. Both cultures isolated Candida parapsilosis sensitive to
amphotericin. These patient cases highlight that evacuation of the anterior chamber infiltration in recalcitrant fungal
keratitis and
intracameral injection of
amphotericin B can be an effective adjuvant
therapy.