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  • Title: Successful management of recalcitrant fungal keratitis with topical caspofungin.
    Author: Goel S, Sharma A, Sinha R.
    Journal: GMS Ophthalmol Cases; 2022; 12():Doc19. PubMed ID: 36299295.
    Abstract:
    OBJECTIVE: To report a case of recalcitrant fungal keratitis successfully managed with topical caspofungin acetate in North India. METHODS: Case report and literature review. RESULTS: An 18-year-old male patient presented with complaints of redness, watering, pain and diminution of vision in the right eye and was referred to our centre as a case of corneal ulcer. The patient was examined and found to have a near total epithelial defect, with corneal infiltrates approximately 8x8 mm. A provisional diagnosis of polymicrobial keratitis was made based on corneal scraping suggestive of S tap h ylococcus aureus and confocal scan revealing fungal hyphae. The patient failed to respond to topical voriconazole 1%, natamycin 5% and moxifloxacin hydrochloride 0.5% with oral voriconazole. In view of the poor response to these drugs, the patient was subsequently administered topical caspofungin 0.5% in place of natamycin and continued on topical and oral voriconazole, in addition to topical moxifloxacin and cycloplegics, which finally led to healing with minimal scarring. The patient attained a best corrected visual acuity (BCVA) of 6/12. CONCLUSION: Topical caspofungin may be used as a useful and effective alternative in cases of recalcitrant fungal keratitis. It may result in healing with minimal scarring.
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