Successful Penetrating Keratoplasty for Severe Fungal Corneal Ulcers in Cipto Mangunkusumo Hospital Indonesia

1. Triwijayanti
2. Made Susiyanti

Cipto Mangunkusumo Hospita, Jakarta, Indonesia

Purpose
To report a case of severe fungal corneal ulcer with hypopion which has been successfully treated with therapeutic penetrating keratoplasty in Ciptomangunkusumo Hospital Indonesia.

Method
A 24-years-old female presented with 1-week history of blurred vision and redness in the right eye, later there was a whitish lesion in the cornea. The visual acuity (VA) of the right eye was light perception. There was 10 mm ulcer in the central cornea, depth of the ulcer was 1/3 part of the stromal and also there was 3 mm hypopion at the anterior chamber. Ultrasound examination revealed no haziness in posterior segment. He was treated with Natamycin eye drop (ED) hourly, Sulfas Atropin 1 % ED 3 times, artificial tear ED 6 times, Itrakonazole 1x200mg. The lesions was not improved, therefore therapeutic penetrating keratoplasty was performed. The recipient cornea was cut with trephine 10.50 mm and the cornea donor with trephine 11.00 mm. The cornea was sutured by interrupted nylon 10.0. Antifungal oral and ED were given post operatively and followed by steroid ED five days later

Result
One day postoperative, VA was hand movement, the corneal graft was edematous. After four months the best corrected VA was 6/7,5.

Conclusion
Severe fungal corneal ulcer should be treated with antifungal agent but frequently fail to preserve the eye ball and the vision. Penetrating keratoplasty is ideal to treat nonhealing fungal keratitis threatening perforation and gave a succesful result in eliminating the fungal and improving the visual acuity in this patient.