Fungal keratitis is an ocular infection that has no standardized treatment. The etiological agents most frequently reported in the literature are Fusarium spp., Aspergillus spp., Alternaria spp. and Curvularia spp., related to injuries and Candida albicans related to contact lens wear. Here we present a case of bilateral fungal keratitis of a few days of evolution with insufficient response to antifungal pharmacological treatment and with early application of cross-linking in both eyes as an adjuvant therapy. A review of the current status of cross-linking for the treatment of corneal infections is presented.
This work reports on a clinical case of a female who presented with headache, bilateral eye pain and vision loss. Intraocular pressures were 40 mm Hg in the right eye and 45 mm Hg in the left eye. Optical Coherence Tomography examination shows the iridocorneal angle was collapsed and macular striae were also observed. The patient had been on topiramate due to migraines 7 days before presentation. Diagnosis for topiramate-induced acute angle closure was made in both eyes. The patient showed improvement in symptoms a few days after treatment initiation and images confirmed that the iridocorneal angle had been enlarged and macular striae had disappeared.
The phototoxic effects of FQs on the cornea may lead surgeons to consider another antibiotic class for prophylaxis against infectious keratitis in UV-CXL. These effects, along with the known cytotoxic effects of FQs independent of UV radiation, may contribute to some of the complications of corneal UV-CXL. Dosage studies may be warranted.
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