A 71-year-old woman with a history of type 2 diabetes mellitus was referred for corneal ulceration of probable herpetic etiology of the left eye for two months, accompanied by mild eye pain.
The patient reported having suffered ocular inflammation associated with frontal dermatitis, compatible with herpes zoster, two years earlier.
In the first visit, the visual acuity was 0.4 in the right eye and counting fingers at 1 meter in the left eye, mild bilateral cataract, normal cough and eye fundus without significant changes in both eyes.
In the left eye, a superficial and central corneal ulceration was observed, with well-defined infiltrates at the edges, associated with an inflammatory reaction in the anterior chamber (cell wall 2+).
Samples were taken for microbiological culture by corneal scraping. Oral itraconazole 200 mg/24h was prescribed, associated with topical treatment with amphotericin B 0.15%, cefazolin 50 mg/ml and tobramycin based on suspicion.
Culture showed growth of Candida albicans, reason why the same treatment was maintained.
Corneal perforation worsened rapidly up to 6 days, preceded by a significant increase in pain, severe hyperemia, extension of corneal epithelial defect, appearance of necrosis and ocular hypertension,
An amniotic membrane transplantation (triple layer) was performed urgently, preceded intraoperatively by a new sample collection by corneal scraping for microbiological culture.
The result of this culture (aerobic and anaerobic) was negative for bacteria.
Medical treatment was initiated with intravenous voriconazole (200 mg/24 h) associated with oral aceclofenac, artificial synthetic preservatives and topical brimonidine.
After 10 days, intravenous administration of voriconazole (200 mg/24 h) was suspected and maintained for 6 weeks.
The clinical picture responded favorably to treatment, progressively disappearing inflammatory signs during the first 15 days.
The patient only presented blurred vision at the beginning of treatment and a slight increase in LDH in blood, without other side effects.
Good integration of amniotic membrane graft was observed, but later required a penetrating keratoplasty due to residual corneal scarring (adherent leukemia).
