A Case Report on Fortified Drop Toxicity in Refractory Stromal Abscess.
Varsha Manade, Megha R Kotecha, Jessica Sangwan et al.
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Case in brief
A 79-year-old patient with diabetes presented with a severe corneal stromal abscess, corneal haze, midstromal infiltrates, a 1 mm hypopyon, and hand-movement best-corrected visual acuity. Corneal scraping culture was negative, and Gram and KOH stains showed no evidence of bacterial, fungal, or Acanthamoeba infection. Fortified topical antibiotics given every 2 hours were followed by a 7 mm × 5 mm epithelial defect and no significant symptomatic improvement after 1 week. Intrastromal vancomycin and amikacin with topical antibiotics also failed to produce significant improvement, and therapeutic penetrating keratoplasty was performed to control infection and restore corneal integrity.
What made this case unusual
The case illustrates epithelial toxicity during intensive fortified-drop treatment of a culture-negative, refractory stromal abscess, with a large epithelial defect developing during therapy.
Diagnostic / clinical pearl
A negative corneal scraping culture and stains did not resolve the diagnostic uncertainty in this deep stromal abscess; the report also highlights the need to consider epithelial toxicity during intensive fortified topical antibiotic treatment.