Gerbert Rebell

Dematiaceous fungal keratitis. Clinical isolates and management.

Clinical and laboratory features of 16 cases of keratitis that were caused by dematiaceous pigmented fungi are reported. Management, including the treatment of nine cases with Natamycin (Pimaricin), resulted in corneal healing in 14 cases, and therapeutic surgery in two cases.

Animal Model of Fusarium Solani Keratitis

Because of the frequency of fungal keratitis due to Fusarium solani, we needed a sustained, progressive infection in an animal model to determine the mechanisms of pathogenicity and to evaluate the new antifungal agents. Pigmented rabbits interlamellarly injected with actively germinating conidia from lyophilized temperature-tolerant strains of F. solani produced sustained culture-positive ulcers in high percentage of eyes at two and three weeks, pretreatment with subconjunctival corticosteroids was necessary. Histopathology, although a poor index of infectivity since some corneas with plentiful hyphal fragments had negative cultures, simulated human fungal pathology.

Therapeutic surgery in failures of medical treatment for fungal keratitis.

Medical treatment failure necessitated surgery in nine cases of fungal keratitis. Therapeutic surgery eliminated fungal infection in seven cases, and useful vision was retained in five out of six penetrating keratoplasties. In three cases Natamycin (Pimaricin) therapy rendered fungi non-viable, but two were demonstrable by histopathology. These results suggest that antifungal treatment should be applied for as long as possible before therapeutic surgery in order to improve the final visual outcome.

Listeria Monocytogenes Endophthalmitis with a Black Hypopyon

A 68-year-old woman had a marked decrease in visual acuity, increased intraocular pressure, and acute iridocyclitis. She developed a pigmented hypopyon simulating an occult intraocular melanoma. Two anterior chamber paracenteses showed growth of Listeria monocytogenes. The patient received systemic intravenous penicillin, topical fortified gentamicin sulfate drops, and intraocular injections of cephaloridine. On discharge from the hospital after a two-week stay, visual acuity had improved and intraocular pressure had decreased.

Methenamine-Silver-Stained Corneal Scrapings in Keratomycosis

A shortened version of Grocotts methenamine-silver technique for use in staining corneal scrapings was superior to current methods for the diagnosis of mycotic keratitis.

Recurrent Keratitis Due to Acremonium Potronii

In a 15-year-old boy a culture-proved keratitis after a corneal perforation healed without antifungal agents after corneal suturing and application of tissue glue. Eight months later a posterior corneal abscess developed. Diagnostic and therapeutic penetrating keratoplasty was performed when the lesion failed to respond to pimaricin. Cultures were positive for Acremonium potronii, the same fungus isolated from the original corneal laceration eight months previously. To our acknowledge, this is the first case report of a central corneal ulcer or abscess due to this specific organism.