Anterior segment OCT in fungal keratopathy for effective therapeutic keratoplasty

Introduction: fungal keratitis (FK) presents significant challenges in management due to its high risk of vision loss. Delayed diagnosis and limited efficacy of ocular medications often necessitate a combination of topical and systemic antifungal therapies alongside surgical interventions, such as therapeutic keratoplasty.<br/><br/>Methods: we conducted a retrospective case series study examining the surgical management of FK at the Eye Unit, Southampton General Hospital, over a 12-month period. Anterior segment optical coherence tomography (AS-OCT) was used to guide therapy and optimize surgical timing.<br/><br/>Results: three cases of FK were managed surgically:<br/><br/>Case One: presented with impending corneal perforation confirmed via AS-OCT. The patient underwent full-thickness keratoplasty but experienced graft failure nine months later, requiring re-grafting.<br/><br/>Case Two: presented with corneal perforation requiring urgent corneal gluing, followed by therapeutic penetrating keratoplasty guided by AS-OCT. Vision improved from hand motion to counting fingers.<br/><br/>Case Three: presented with bilateral FK without stromal thinning or perforation. AS-OCT assessed infection depth, guiding superficial keratectomy in both eyes and deep anterior lamellar keratoplasty (DALK) in the right eye. Vision improved to 6/60.<br/><br/>Conclusion: AS-OCT is a valuable tool for guiding surgical timing and approach in FK management. Its integration with medical therapies facilitates effective therapeutic clearance of fungal infections, preserves ocular integrity, and stabilises or improves vision in severe FK cases.