Surgical Management of Refractory Fungal Endothelial Exudates

Monday, April 20, 2015: 3:50 PM
Room 3 (San Diego Convention Center)
Arundhati Borthakur, MD

To evaluate the role of anterior chamber tap and lavage with antifungal agents in cases of refractory fungal endothelial exudates.

This retrospective, non-randomized case series included 5 eyes of 5 patients of diagnosed fungal keratitis with minimal  corneal stromal infiltration but with profuse endothelial exudates which was refractory to maximum medical treatment. All patients subjected to a surgical aspiration of the exudates followed by lavage of the anterior segment with Inj. Voriconazole. Topical antifungal medications were continued with frequent follow-up.

Complete resolution of corneal infiltration along with absence of endothelial exudation and formation of corneal scar was considered as the end point of treatment. All 5 eyes showed complete resolution with scar formation within 2 weeks of the surgical intervention. These patients were taken up for optical penetrating keratoplasty (PK) after 6 months of healing. This ensures better graft survival and visual rehabilitation in such patients of infectious kertitis.

Early surgical intervention with minor surgical procedures like anterior chamber tap and lavage  in  refractory cases of infectious keratitis with primary endothelial exudates can ensure resolution of the infective condition with formation  of scar. Penetrating keratoplasty at a later stage ensures better graft survival with visual rehabilitation.