๐๐ถ๐ฏ๐จ๐ข๐ญ ๐๐ญ๐ค๐ฆ๐ณ- ๐๐ช๐ข๐จ๐ฏ๐ฐ๐ด๐ช๐ด ๐ข๐ฏ๐ฅ ๐๐ข๐ฏ๐ข๐จ๐ฆ๐ฎ๐ฆ๐ฏ๐ตโฃ
โฃ
The picture shows a KOH mount showing filamentous septate hyphae โฃ
โฃ
๐๐ถ๐ฎ๐ด๐ป๐ผ๐๐ถ๐:โฃ
โ Corneal scraping- both diagnostic and therapeuticโฃ
โ AC tapโฃ
โ Corneal biopsyโฃ
โ PCRโฃ
โ Confocal microscopy โฃ
โฃ
๐ฆ๐๐ฎ๐ถ๐ป๐ ๐๐๐ฒ๐ฑ:โฃ
โ KOH mount with Calcoflour whiteโฃ
โ Gramโs stainโฃ
โ Giemsa stainโฃ
โ Lactophenol cotton blueโฃ
โ PAS stainโฃ
โ Grocottโs Methenamine-silver stainโฃ
โฃ
๐๐๐ป๐ด๐ฎ๐น ๐ฐ๐๐น๐๐๐ฟ๐ฒ:โฃ
โ Sheep blood agarโฃ
โ Chocolate agarโฃ
โ Sabouraud dextrose agar (without cycloheximide) - should contain 50โฃ
micrograms /ml gentamicin and should be without cycloheximide as the latterโฃ inhibits saprophytic fungi.โฃ
โ Thioglycollate broth - possible growth of anaerobic bacteria at 35 C to 37 C.โฃ
โ Brain heart infusionโฃ
โฃ
๐ ๐ฅ๐ฆ๐ง๐ช๐ฏ๐ช๐ต๐ช๐ท๐ฆ ๐ฅ๐ช๐ข๐จ๐ฏ๐ฐ๐ด๐ช๐ด ๐ฐ๐ง ๐ง๐ถ๐ฏ๐จ๐ข๐ญ ๐ฌ๐ฆ๐ณ๐ข๐ต๐ช๐ต๐ช๐ด ๐ช๐ด ๐ฎ๐ข๐ฅ๐ฆ ๐ช๐งโฃ
1. Corneal scrapings reveal fungal elements in smears.โฃ
2. Fungus grows in more than one medium in the absence of fungus in smears.โฃ
3. Fungus grows on a single medium in the presence of fungus in smears.โฃ
4. Confluent growth of fungus appears at the inoculated site on a single solidโฃ
medium.โฃ
Initial growth occurs within 72 hours.โฃ
โฃ๐ ๐ฎ๐ป๐ฎ๐ด๐ฒ๐บ๐ฒ๐ป๐:โฃ
๐ ๐ฒ๐ฑ๐ถ๐ฐ๐ฎ๐น:โฃ
โ Topical antifungal agentsโฃ
Natamycin 5% suspension โ initial choiceโฃ
Topical amphotericin 0.15% in cases of Candida/Aspergillus Fluconazole 0.3%/Miconazole/Voriconazole in cases of Fusariumโฃ
โ Intracameral Amphotericin B- 5 ug in 0.1ml 5% dextroseโฃ
โ Intrastromal therapy Amphotericin B 5-7.5 ugโฃ
โ Subconjunctival injection in cases of scleritisโฃ
โ Systemic antifungals (eg. Ketoconazole) given in:
Severe deep keratitis
Limbal involvement
Scleritis, Endophthalmitis
Prophylactic after TPK
Virulent fungusโฃ
โ Cycloplegicsโฃ
โ Anti glaucoma drops if IOP is highโฃ
โฃ
๐ฆ๐๐ฟ๐ด๐ถ๐ฐ๐ฎ๐น:โฃ
โ Debridement- Debulks organisms & necrotic material and enhances penetration of topical antifungals. Every 24-48 hours.โฃ
โ Biopsyโฃ
โ Conjunctival flapsโฃ
โ Therapeutic keratoplasty:โฃ
When progression is noted and involves limbus/scleraโฃ
Endophthalmitis
Impending perforations/frank perforations
No response to therapyโฃ
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