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Journal of Case Reports
Fungal Infection in Clear Corneal Incision Wound Leads to Acute Endophthalmitis Post Phacoemulsification: A Case Series

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Faresa Hilda1, Rina La Distia Nora2, Made Susiyanti2
From the 1Ophthalmology Department and 2Infection & Immunology Division, Ophthalmology Department, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Corresponding Author:
Dr. Faresa Hilda
Email: faresahilda@gmail.com
Received: 04-AUG-2014 Accepted: 13-OCT-2014 Published Online: 10-NOV-2014
DOI: http://dx.doi.org/01.2014.0110
Objective: To report rare cases of fungal infection in clear corneal incision wound after phacoemulsification leading to acute endophthalmitis. Methods: Two patients underwent uneventful phacoemulsification. First patient was 55 year old diabetic man while second patient was 59 year old woman with history of steroid oral consumption. Both patients complained of sudden blurred vision, redness, pain since 4 days and 1 week after surgery respectively. They had corneal stitch surrounded by infiltrate. Aspergillus flavus was isolated from both corneal cultures and ultrasonography revealed vitreous haziness. First patient underwent vitrectomy, antibiotic, antifungal intravitreal injection. Second patient received antifungal intravitreal injection, antifungal therapies.  Both patients underwent therapeutic keratoplasty in view of progressive infiltrates. Results: After antibiotic, antifungal intravitreal injection, vitrectomy, therapeutic keratoplasty, VA of first patient was hand movement. After antifungal intravitreal injection, repeated therapeutic keratoplasty, VA of second patient was 3 meters finger counting. Both had clear corneal graft and significant reduction of anterior segments’ infection. Conclusion: Acute endophthalmitis after phacoemulsification caused by fungal wound infection is rare. Source of infection is inconclusive but surgical instruments’ contamination, diabetes mellitus and steroid consumption are the possible causes. 
Keywords : Antifungal Agents, Cornea, Endophthalmitis, Intravitreal Injections, Aspergillus flavus, Humans.
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