Scedosporium apiospermum and Lomentospora prolificans emergent ocular infections in North India

Of included eight cases, Scedosporium apiospermum was identified in five cases (including teleomorph state Pseudallescheria boydii and Graphium form) and Lomentospora prolificans was identified in three cases. The mean time to presentation at our hospital from the commencement of clinical disease was 19.2 days (range 1-30 day). History of trauma was present in five (83.3%) of six patients. Different clinical presentations predominantly included keratitis followed by endophthalmitis. Two cases (culture positive Lomentospora prolificans) with provisional diagnosis of fungal keratitis presented with complete corneal melt. Medical management alone with natamycin was successful in two cases, while other patients required surgical intervention in addition to medical management. Scleral involvement and vitreous involvement were associated with poor prognosis. The average time to healing in noted in our series was ~ 90 days. Thus, prompt diagnosis is critical for commencing targeted antifungal therapy as these fungi are resistant to many antifungal agents. Oral and topical antifungals along with surgical management (therapeutic penetrating keratoplasty) were successful for the treatment of S. apiospermum/L. prolificans oculomycosis involving the posterior segment of the eye.