Alternaria keratitis after uneventful phacoemulsification in an otherwise healthy adult

BACKGROUND: Fungal infections of self-sealing corneal incisions in cataract surgery are scarce. We report a case of Alternaria keratitis, several weeks after uneventful clear-cornea phacoemulsification. FINDINGS: A 42-year-old woman, with a history of retinitis pigmentosa, complained of painful red right eye, 45 days after uneventful self-sealing clear-cornea phacoemulsification. Slit-lamp examination revealed multiple snow-like contiguous stromal infiltrates, with irregular margins, and no epithelial defect. These infiltrates were unresponsive to topical quinolones and topical corticosteroids as well as oral valaciclovir. Culture from corneal biopsy specimen grew Alternaria species. Management consisted of topical amphotericin-B, and then a combination of topical and oral voriconazole. The corneal infiltrates progressively healed. One year later, the best-corrected visual acuity was 20/400. CONCLUSIONS: Fungal infection, particularly Alternaria keratitis, should be considered in the differential diagnosis of delayed post-cataract surgery keratitis. Prompt diagnosis and management are mandatory to improve visual prognosis.