Loteprednol etabonate
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Dematiaceous fungal colonisation by Bipolaris species in the left eye: case report A 75-year-old man developed dematiaceous fungal colonisation by Bipolaris species in the left eye during treatment with loteprednol etabonate for peripheral ulcerative keratitis (PUK). The man presented with 2 years’ history of defective vision, recurrent pain and redness in the left eye in October 2019. The clinical findings confirmed diagnosis of PUK. Bandage contact lens (BCL) was placed over the cornea following application of cyanoacrylate tissue adhesive. He received topical 0.5% loteprednol etabonate four times a day along with concomitant administration of carmellose [carboxymethyl cellulose] and moxifloxacin. One month later, his best corrected visual acuity (BCVA) had improved. The therapy was continued, and topical loteprednol etabonate was tapered. He was advised for a follow-up after one month. However, due to COVID-19 lockdown, he was lost to follow-up. Five months later, he presented with complaints of pricking sensation and defective vision in the left eye. He was diagnosed with perforated corneal ulcer provisionally in the outpatient department and was referred to the cornea department for further evaluation. On examination, his BCVA for distance was counting fingers at 1m in bilateral eye examination. Slit lamp examination of the left eye revealed a brownish black pigmented, lumpy deposits over the cornea under the BCL. Anterior segment optical coherence tomography (AS-OCT) revealed a corrugated, irregular corneal contour with an area of hyper-reflectivity under the BCL, consistent with accumulation of deposits. BCL was removed. After BCL removal, cornea was re-evaluated. Repeat AS-OCT showed lumpy bumpy corneal surface irregularity. The clinical findings confirmed dematiaceous fungal colonisation beneath the BCL without any corneal involvement. Microbiological examination with potassium hydroxide, sabouraud dextrose agar and lactophenol cotton blue was analysed. Based on the conidia and colony morphology, the fungal organism named Bipolaris species was identified. Loteprednol etabonate was discontinued. He received treatment with natamycin and carmellose. One week later, the BCVA in the left eye for distance improved and corneal was found to be relatively clear with regular and smooth surface. AS-OCT revealed a uniform and smooth corneal contour. Natamycin was discontinued, and carmellose was continued. At the last follow-up after one month, the cornea was found to be relatively clear with no evidence of inflammation or infection. Srirampur A, et al. Dematiaceous Fungal Colonization of the Bandage Contact Lens in a Patient Lost to Follow-up During the COVID-19 Crisis. Eye and Contact Lens 46: 803518438 e66-e68, No. 6, Nov 2020. Available from: URL: http://doi.org/10.1097/ICL.0000000000000751
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Reactions 5 Dec 2020 No. 1833
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