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Inicio Archivos de la Sociedad Española de Oftalmología (English Edition) Therapeutic sectorial full-thickness sclero-keratoplasty for recurrent fungal ke...
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Vol. 90. Issue 8.
Pages 385-388 (August 2015)
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Vol. 90. Issue 8.
Pages 385-388 (August 2015)
Short communication
Therapeutic sectorial full-thickness sclero-keratoplasty for recurrent fungal keratitis
Escleroqueratoplastia terapéutica sectorial de grosor completo en queratitis fúngica recurrente
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M. Barbany
Corresponding author
miriambarbany@gmail.com

Corresponding author.
, O. Gris, J.L. Güell
Instituto de Microcirugía Ocular (IMO), Universitat Autònoma de Barcelona, Barcelona, Spain
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Abstract
Objective

To report the management of a severe and recurrent fungal keratitis that required repeated penetrating keratoplasties. Despite multiple topical, intraocular and systemic antifungal treatments, superotemporal hyphal infiltration repeatedly penetrated the corneal transplant causing continuous recurrences. Cultures collected before and during surgery isolated the same organism, Fusarium spp.

Conclusion

Corneal infection extending to the sclera and internal angle structures is the main cause of recurrence of fungal keratitis after corneal transplantation. Sectorial full-thickness sclero-keratoplasty combined with a central penetrating keratoplasty should be a surgical technique to be considered in cases where these locations are suspected to be the source of recurrence. It enables a definitive elimination of the infection, with excellent final visual acuities. No postoperative complications were reported in this case.

Keywords:
Corneal transplant
Fungal keratitis
Recurrent keratitis
Sectorial sclero-keratoplasty
Resumen
Objetivo

Comunicar el manejo de una queratitis fúngica recurrente severa, que requirió repetidas queratoplastias penetrantes. A pesar de los múltiples tratamientos antifúngicos tópicos, intraoculares y sistémicos, una infiltración micótica superotemporal repetidamente penetraba y descompensaba al trasplante corneal. Los cultivos preoperatorios y operatorios aislaron al mismo organismo, Fusarium spp.

Discusión

La infección corneal que se expande a la esclera o a las estructuras del ángulo interno es la causa más frecuente de recurrencia en la queratitis fúngica después del trasplante de córnea. En estos casos, la escleroqueratoplastia sectorial de grosor completo del sitio sospechoso de recurrencia, asociada a una queratoplastia penetrante central, debería ser una técnica quirúrgica a considerar ya que permite una eliminación definitiva de la infección con excelentes resultados de agudeza visual final. Ninguna complicación postoperatoria ha sido registrada en este caso.

Palabras clave:
Trasplante de córnea
Queratitis fúngica
Queratitis recurrente
Escleroqueratoplastia sectorial

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