Contact Lens–Related Fusarium Infection: Case Series Experience in New York City and Review of Fungal Keratitis

Abstract

A delay in diagnosis and prolonged treatment delay of Fusarium keratitis is associated with significant comorbidity. Physicians must have a higher index of suspicion for fungal keratitis in contact lens wearers to facilitate in early diagnosis and treatment.

Microbial keratitis

“…7,59,60 Such therapy is not always successful. Proenca-Pina et al 61 described the clinical course of a Fusarium keratitis which failed to respond to systemic and local voriconazole treatment, and experienced a progression to a severe keratitis with endophthalmitis, requiring early therapeutic keratoplasty.…”

“…Hu et al 7 presented a case series of patients with contact lens associated fungal keratitis and reported a key symptom common to all cases reviewed -a sharp pain on removal of the lens from the eye after experiencing initial discomfort. This was followed by increased tearing, redness, and photosensitivity.…”

Role of Biofilms in Fungal Keratitis- An Overview

“…High risk of fungal keratitis in contact lens wearers has been associated with the ability of the lens to induce modification of the corneal epithelium and to carry organisms to the ocular surface [25,26]. Use of lens induces local alterations like hypoxia and hypercapnia, which affect the ability of the epithelium to respond to damage.…”

“…Use of lens induces local alterations like hypoxia and hypercapnia, which affect the ability of the epithelium to respond to damage. Tear fluid exchange may also be compromised between the anterior and posterior sides of the lens thereby limiting its antimicrobial properties [25]. In addition, contact lenses provide a surface where microorganisms may attach and colonize the surface as a biofilm and can spread to a previously damaged corneal epithelium [26].…”

Rifampin Enhances the Activity of Amphotericin B against Fusarium solani Species Complex and Aspergillus flavus Species Complex Isolates from Keratitis Patients

“…Keratomycosis is notoriously difficult to treat. Amphotericin B is one of the most commonly used topical agent to treat keratomycosis (11, 12); however, nonsusceptibility to amphotericin B has been recently reported for filamentous fungi (13-16), and some studies have shown that the response rates to amphotericin B for Fusarium keratitis and Aspergillus keratitis are 56% and 27%, respectively (11,17,18). Therefore, there is an urgent need for new approaches to manage amphotericin B-nonsusceptible filamentous fungi.…”