Fungal Corneal Ulcer Successfully Treated with Topical Fluconazole and Natamycin, and Additional Amniotic Membrane Transplantation: A Case Report

Abstract

A fungal corneal ulcer, is an infection of the corneal stroma that can cause rapid vision loss and pain. It needs to be treated as soon as possible to preserve vision (Kulkarni et al., 2017). It may be caused by filamentous (Fusarium or Aspergillus species) or non-filamentous fungi (Candida species). American Academy of Ophthalmology, 2016). Case Illustration show a 33-year-old man complaint about having pain and redness on the right eye for the last 3 weeks. The black area suddenly whitened two days later and became wider. Hyperlacrimation, discharge, and glare also exist. No known history of previous trauma. His best-corrected visual acuity (BCVA) was 1/300. Slit-lamp examination revealed an oval-shaped corneal defect at a central zone sized of 5x7.5 mm, grayish-white, dry-appearing stromal infiltrate that has regular feathery margins, ring ulcer, positively fluorescence test, and minimal hypopyon. Fungal septate hyphae are seen on gram staining. He treated with oral ketoconazole, topical fluconazole and natamycin, atropine as a cycloplegic, and additional AMT. Visual acuity then improved and the ulcer became cicatricial in one month. Our case is typical for fungal corneal ulcer by its presentation and microbiological examination. Known for its long and protracted course, there is no definitive therapy established yet and each antifungal agent has its benefits and limitations. However, in our patient, oral administration of ketoconazole, topical natamycin and fluconazole, and AMT for adjunction, had succeeded in eliminating the infection and showing significant changes. Our case reported that a fungal corneal ulcer is successfully treated with combination of topical natamycin and fluconazole and additional AMT.