Purpose: This report discusses a case of multidrug-resistant fungal keratitis associated with contact lens use, complicated by corneal perforation and managed with cyanoacrylate tissue adhesive application.
Case report: A 51-year-old previously healthy female patient with a history of extended-wear soft contact lens use for approximately five years was referred to our clinic due to decreased vision in her left eye over three weeks. Her visual acuity was 20/20 in the right eye and hand motion in the left eye. Slitlamp examination revealed an expansive infiltrate involving all layers of the cornea of the left eye. The infectious pathogen was identified as Fusarium . After one week of medical treatment, corneal perforation occurred in the left eye, leading to the application of cyanoacrylate tissue adhesive to ensure globe integrity in the short term. After six months, slitlamp examination revealed no reactivation, prompting the removal of the cyanoacrylate from the corneal surface. Approximately one year later, tectonic penetrating keratoplasty and phacoemulsification surgeries were performed for visual rehabilitation. Subsequent vision improvement was observed, with the final best-corrected visual acuity (logMAR) of the left eye reaching 0.3.
Conclusion: This case study demonstrates the complexity of managing multidrug-resistant fungal keratitis. The authors would like to highlight that the application of cyanoacrylate tissue adhesive is an immediate therapeutic option, due to its anatomical effect on globe integrity and potential antifungal properties, which can help reduce the risks associated with corneal transplantation.
Keywords: Contact lens; Corneal perforation; Cyanoacrylate tissue adhesive; Fungal keratitis.
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