case_images: PMC10690767_01
case_images: Changes in the patient's corneal condition before penetrating keratoplasty. (A,B) Show slit-lamp and sodium fluorescein staining at the first visit, respectively. (C,D) Show slit-lamp and sodium fluorescein staining after 6 days of antifungal treatment, respectively.
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case_images: fig1
case_images: Slit-lamp anterior segment examination revealed conjunctival congestion, feather-like greyish-white corneal deep stromal infiltrate, white, floccular material sprawling from the anterior chamber angle and a 1.5 mm hypopyon (Figures 1A,B). Despite the intense topical therapy, the infiltrate spread extensively to all corneal layers, forming a white floccular structure attached to the pupillary region, as shown in Figures 1C,D, 2B.
case_images: Anterior segment optical coherence tomography (AS-OCT) shows the changes of cornea and the anterior chamber angle before penetrating keratoplasty. (A) Shows the AS-OCT images at the first visit. (B) Shows the AS-OCT images after 6 days of antifungal treatment.
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case_images: fig2
case_images: Anterior segment optical coherence tomography (AS-OCT) showed infiltrated and opaque corneal stroma and an abundance of exudates attached to the endothelium (Figure 2A). Despite the intense topical therapy, the infiltrate spread extensively to all corneal layers, forming a white floccular structure attached to the pupillary region, as shown in Figures 1C,D, 2B.
case_images: IVCM showed massive hyperlinear structures in the deep stromal layer which implies fungal infection.
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case_images: The in vivo confocal microscopy (IVCM) images showed groups of hyperlinear structures in the deep stroma that were typical signs of fungal hyphae, as shown in Figure 3.
case_images: Slit lamp photo after penetrating keratoplasty. (A,B) Show slit-lamp and sodium fluorescein staining at the 6 days after keratoplasty, respectively. (C,D) Shows slit-lamp and sodium fluorescein staining two and a half months after keratoplasty.
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case_images: fig4
case_images: The patient was discharged, as depicted in Figures 4A,B. Following two and a half months, topical antifungal therapy was discontinued after ensuring no reactivation of the C. cassiicola infection by IVCM, and add 0.05% cyclosporin A for immunosuppressive therapy (Figures 4C,D).
case_images: Timeline of the patient' s disease progression and the corresponding treatment.
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case_images: fig5
case_images: Timeline of her disease progression is shown in Figure 5.