Successful treatment of Fusarium solani anterior chamber involvement secondary to contact lens associated corneal ulcer with intracameral Amphotericin B

Background: Fusarium spp. are leading fungal pathogenes in contact lens associated keratitis and may evoke endophthalmitis. Since Fusarium spp. are highly resistant to antifungal drugs, globe integrity is threatened. Case: A woman developed fungal anterior chamber involvement after contact lens associated corneal ulcer formation. She presented with a painful eye with hypopyon and a mass presumably of fungal origin growing on the iris and anterior lens capsule. A biopsy confirmed Fusarium solani. Only multiple lavages of the anterior segment with Amphotericin B achieved convalescence. Conclusion: In the initial stage of contact lens associated keratitis, it is often hard to differentiate between etiology. However, keratitis which are treatment resistant to antibacterials are suspicious for fungal origin. For proper treatment, identification of pathogen is crucial. Due to poor tissue penetration of the lipophilic anti-fungal agents and slow fungal replication rate, multiple lavages of the anterior chamber are often required to handle fungal infections.