Recalcitrant Fungal Corneal Ulcer

The cornea forms the major refracting surface of the eye. Any disease affecting the cornea leads to severe visual impairment. One of the most common pathologies affecting the cornea is infective keratitis. In India, especially in rural areas, infective corneal ulcers are major causes of visual impairment. Medical therapy with antimicrobial medicines is usually started first and if fails to heal the ulcer or there is progressive corneal thinning or corneal perforation then surgical treatments like penetrating keratoplasty are the only modality to salvage the globe integrity. Fungal keratitis particularly in tropical and subtropical areas has a poor prognosis as compared to bacterial keratitis. The main reasons for poor outcomes are delayed diagnosis and a lack of effective antifungal therapies. Over the last decade, significant advances have been made in quick diagnosis in cases of mycotic keratitis and also effective medical treatment. We report a case of a 56-year-old female who was diagnosed with left eye fungal corneal ulcer on systemic and topical antifungal agents for the last two months. She presented to us with an increase in pain, watering, and redness in her left eye for the past two days. On examination, the patient had desmetocele with impending perforation. The patient was advised to undergo therapeutic penetrating keratoplasty in her left eye. Penetrating keratoplasty plays a crucial part in eyes with refractory keratitis, impending perforation, or eyes with corneal perforation. Penetrating keratoplasty in such cases helps to replace the diseased tissue, decrease the infective load, and also helps to restore anatomical integrity of the globe and usable eyesight with good success rate. Early intervention prior to perforation or limbal/scleral extension can lead to better results at least in maintaining the globe integrity.