Role of intracameral Caspofungin in the management of Aspergillus keratitis: A case report

Abstract

Abstract A 48-year-old male patient with a history of fall of dust in his right eye while driving came for a second opinion. On examination, he had a dry-looking ulcer with feathery margins and a hypopyon, suggestive of fungal keratitis. Scraping showed septate fungal filaments. Aspergillus niger grew in culture, and the patient was asked to use frequent natamycin eye drops. However, the hypopyon continued to increase, so ketoconazole tablets were added. Intracameral injection of Amphotericin B was advised, but in view of a severe shortage of the drug in the region, injection of Caspofungin (CAS) was given intracamerally with patient consent. With a combination of oral, topical, and intracameral antifungal medication, the ulcer slowly resolved over a period of 1 month, leaving behind a nebulomacular corneal scar in a quiet eye. Intracameral CAS may provide a safe and effective alternative to voriconazole and amphotericin B in the setting of Aspergillus keratitis.