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JE Kim, SL Perkins; Fungal Scleral Buckle Infection with a Nodular Abscess: a Case Report . Invest. Ophthalmol. Vis. Sci. 2002;43(13):1610.
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Purpose: To report a case of fungal scleral buckle infection that was refractory to conventional antifungal therapy but responded to a new antifungal agent. Method: Chart review of a case. Results: A 65 year-old immunocompetent woman presented with red and tender left eye with an epibulbar nodule that was slowly growing. Her ocular history was significant for multiple recent vitreoretinal procedures including scleral buckling procedure and lensectomy,and vitrectomy was performed on several occasions. Following each of her surgeries, subconjunctival Depo-medrol injection was given and prolonged topical steroid was used. Upon presentation to us, surgical exploration of the eye was performed. The nodule was found to be an abscess. Scleral buckle could not be removed due to areas of scleral necrosis and fear of globe rupture. Cultures grew out Aspergillus. Topical Amphotericin B and oral ketoconazole were begun. When the eye did not improve, the scleral buckle was removed and she was switched to itraconazole. When the infection was refractory to use of available antifungal agents for 7 months with her continuing to have eye pain and redness as well as severe left sided head aches, an investigational antifungal medication was started after IRB approval of compassionate use. Within 1 week of starting the oral treatment,ocular tenderness and head ache resolved. Over the next 3 months, the redness cleared and ocular alignment improved. Intraocular concentration of the drug was 53% of the plasma concentration in this aphakic patient. Conclusion: Multiple surgical procedures and prolonged use of steroids may predispose an eye to atypical infections. Fungal infection of the eye can present with an epibulbar nodular abscess. New antifungal agent has good intraocular penetration and may have a role in refractory fungal diseases of the eye.
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