Objective: To report 5 cases of fungal keratitis caused by Trichophyton schoenleinii.
Methods: Case reports.
Results: Trichophyton schoenleinii is responsible for aggressive fungal keratitis that is associated with keratolysis as a result of collagenase expression by the organism. Clinically, the organism seems to be sensitive to topical natamycin but resistant to topical amphotericin B and miconazole. Two patients achieved clinical cures with medical therapy alone, but with visual outcomes of only 20/125 and hand motions because of corneal scarring. Two patients achieved clinical cures with therapeutic penetrating keratoplasty (PKP), which remained clear and provided final visual outcomes of 20/60 and 20/200. One patient developed fungal scleritis and panophthalmitis despite 2 therapeutic PKPs and required enucleation.
Conclusion: Trichophyton schoenleinii is a rare cause of fungal keratitis that may be associated with progressive keratolysis and perforation, scleral extension, and endophthalmitis. Therapeutic keratoplasty may be successful in achieving cure in medically unresponsive cases.