case_images: PMC9577386_01
case_images: Clinical photograph on diffuse slit lamp illumination of the right eye at presentation showing (A) a large 8x8 mm infiltrate with circumcorneal congestion and lid edema; (B) after staining with 2% sodium fluorescein, note the near total epithelial defect.
case_images: OC_12-19-g-001.jpg
case_images: PMC9577386_01_OC_12-19-g-001.jpg
case_images: F1
case_images: Snellen visual acuity was hand motion close to the face with accurate projection of rays in the right eye and 6/6 in the left eye. Slit-lamp examination revealed a near total epithelial defect with corneal infiltrates of 8x8 mm extending up to 1/2 of corneal thickness with circumciliary congestion and lid edema (Figure 1 (Fig. 1)).
case_images: Confocal image of the patient showing branching hyphae suggestive of fungal keratitis.
case_images: OC_12-19-g-002.jpg
case_images: PMC9577386_01_OC_12-19-g-002.jpg
case_images: F2
case_images: Confocal microscopy was performed, which revealed the presence of fungal hyphae (Figure 2 (Fig. 2)).
case_images: Clinical photograph on diffuse slit lamp illumination of the right eye (A) on day 7 of starting topical caspofungin; note the reduction in size of infiltrate with evidence of vascularisation suggesting healing; (B) on day 14, further reduction in ulcer size; (C) on day 28, note the evidence of scarring; (D) on cobalt blue illumination showing a residual epithelial defect of 3x2 mm.
case_images: OC_12-19-g-003.jpg
case_images: PMC9577386_01_OC_12-19-g-003.jpg
case_images: F3
case_images: Following the commencement of the treatment, healing of the corneal epithelium and resolution of the corneal infiltrate were observed from the periphery towards the centre with evidence of vascularisation, and the patient showed commendable clinical response (Figure 3 (Fig. 3)).
case_images: Clinical photograph on diffuse slit lamp illumination of the right eye (A) at 6 weeks, showing complete healing of the ulcer with residual stromal scarring; (B) anterior segment optical coherence tomography (ASOCT) showing residual stromal scarring after complete healing.
case_images: OC_12-19-g-004.jpg
case_images: PMC9577386_01_OC_12-19-g-004.jpg
case_images: F4
case_images: Although the patient initially had limbus to limbus corneal infiltrates, the scarring was less dense and involved superficial cornea with relative peripheral corneal sparing (Figure 4 (Fig. 4)).