Phacoemulsification Tunnel Keratitis: A Report of Two Cases with Different Outcomes

Abstract

Abstract

Background: Phacoemulsification tunnel wound keratitis can occur, with various aetiologies. This condition is difficult to treat and often leads to poor visual outcome.

Method: Case report

Results: A 66 year-old diabetic male (Patient 1) and a 68 year-old non-diabetic female (Patient 2) were treated for presumed fungal keratitis at their phacoemulsification tunnel wound sites. They had previously undergone uneventful phacoemulsification through temporal corneal incisions around 4-5 months prior to presentation. Both had prolonged post-operative inflammation which did not respond to topical steroids. Topical and oral antifungals were started after the appearance of suspicious fungal infection stigmata including fern-like infiltrates with fluffy edges and satellite lesions. Patient 1 needed a penetrating keratoplasty, and intracameral voriconazole was given when his condition did not resolve. His best-corrected visual acuity at last review was light perception, as compared to 6/60 at first presentation. Patient 2 was given intrastromal amphotericin B. Her condition improved with best corrected visual acuity being 6/60, compared to 1/60 on presentation.

Conclusion: We should have a high index of suspicion of fungal infections in patients with prolonged inflammation post-phacoemulsification which do not respond to steroids. Early diagnosis and treatment is important because complications of fungal keratitis often result in poor visual prognosis.

Conflicts of interest: The authors declare no conflicts of interest.

Keywords: fungal, phacoemulsification, tunnel, keratitis