Voriconazole-refractory fungal infection of phacoemulsification tunnel

oleh: Mittal Vikas, Mittal Ruchi, Sharma P

Format: Article
Diterbitkan: Wolters Kluwer Medknow Publications 2010-01-01

Deskripsi

A 44-year-old man presented 28 days after cataract surgery (phacoemulsification) in right eye with multiple pinpoint infiltrates in posterior stroma at cataract surgery wound site. Visual acuity was 20/60. Corneal scraping from the floor of the corneal tunnel revealed fungus which was later identified to be <i>Aspergillus flavus</i>. The patient was started on oral voriconazole 200 mg twice daily and topical voriconazole 1&#x0025; every hour. Two intracameral injections of voriconazole (50 micrograms/ 0.1 ml) were given 72 h apart, five days after starting initial therapy. Infiltrates increased in size and density in spite of 20 days of voriconazole therapy. Full-thickness patch graft was done to arrest progressive necrosis. Four months after surgery, patient had 20/60 best-corrected visual acuity. There was no recurrence in one-year follow-up. Present case illustrates the therapeutic challenge in fungal tunnel infections and possibility of voriconazole-resistant <i>Aspergillus</i> species.