Therapeutic Penetrating Keratoplasty for Aspergillus Fungal Keratitis: A Case Report

The purpose of this study was to present a case of fungal keratitis in a 35-year-old farmer successfully managed with therapeutic penetrating keratoplasty (TPK). A 35-year-old male was referred to the emergency department with a 10-day history of a right-eye corneal ulcer. He reported a preceding ocular injury caused by a small stone during farm work. Prior to referral, he had been hospitalized at a tertiary center and treated with topical moxifloxacin and fluconazole without clinical improvement. Clinical examination revealed a corneal ulcer with an endothelial plaque, hypopyon, and fibrin in the anterior chamber. After corneal scraping, empirical treatment for fungal keratitis was initiated. Posterior segment evaluation excluded endophthalmitis. Cultures demonstrated <i>Aspergillus lentulus</i> sensitive to voriconazole. Despite intensive topical and systemic antifungal treatment (voriconazole and amphotericin B), rapid clinical deterioration occurred.<i> </i>Emergency TPK was therefore performed. Emergency TPK was carried out. Diseased corneal tissue, hypopyon, and fibrin were removed, and copious irrigation of the anterior chamber with diluted voriconazole was performed. Instead of topical corticosteroids, postoperative topical cyclosporine A 0.5% was prescribed. Four months after surgery, the patient remains infection-free, with best-corrected visual acuity of 7⁺/10 showing continuous improvement. TPK with meticulous anterior chamber lavage provided a definitive cure for fungal keratitis refractory to topical and systemic therapy. Postoperative administration of cyclosporine A instead of corticosteroids appears to be a safe and effective alternative for graft preservation after TPK for fungal keratitis.