Management of Dematiaceous Fungal Corneal Ulcer

Madona Debora , Angga Fajriansyah, Susi Heryati, Muhammad Arief Mustaram

Madona Debora
Cicendo Naational Eye Hospital Padjadjaran University. Email:

Angga Fajriansyah
Cicendo Naational Eye Hospital Padjadjaran University

Susi Heryati
Cicendo National Eye Hospital Padjadjaran University

Muhammad Arief Mustaram
Cicendo National Eye Hospital Padjadjaran University
Online First: December 01, 2020 | Cite this Article
Debora, M., Fajriansyah, A., Heryati, S., Mustaram, M. 2020. Management of Dematiaceous Fungal Corneal Ulcer. Bali Journal of Ophthalmology 4(2). DOI:10.15562/bjo.v4i2.58

Introduction: Fungal corneal ulcer is a slowly progressive ulcer that may lead to blindness. It is still becoming a challenging problem to diagnose. A brownish plaque in cornea is a diagnostic clue for dematiaceous fungal corneal ulcer. The mainstay therapy are antifungal and debridement of the plaque.

Case report: A 38 years old male patient came with chief complaint of brownish plaque in the center part of the right eye since one month earlier. There was a history of soaking in bevel water. Visual acuity of right eye was hand movement. Slit lamp examination revealed a dry whitish infiltration with feathery edge, a brownish pigmented lesion in the central cornea, and hypopion. This patient was diagnosed as dematiaceous fungal corneal ulcer. Treatment was started with ketoconazole per oral, 5% natamycin eye drop, and 1% cyclopentolate eye drop. There were no clinical improvement after two weeks, therefore keratectomy, anterior chamber washout, intrastromal and intracameral injection of fluconazole were performed. Corneal scrapping was performed intraoperatively. Potassium hydroxide dye showed fungus was found. There was improvement of visual acuity after surgery. There were no brownish plaque and hipopion remained as well as smaller whitish dry found.

Conclusion: Dematiaceous is one of rare case of fungal corneal ulcer. Treatment of fungal keratitis is based on Topical, Systemic, and Targeted Therapy protocol. Surgical intervention is considered in unresponsive case.

Keyword: Corneal ulcer, dematiaceous fungus, keratectomy.

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