Phaeohyphomycosis: A study from tertiary health care center in North India.

Objectives: Phaeohyphomycosis refers to infections caused by phaeoid/dematiaceous or darkly pigmented fungi. This study was undertaken to further increase our knowledge about the incidence of phaeohyphomycosis and its causative agents. Materials and Methods: The present study was conducted over a period of one and a half years (January 2018-June 2019) on specimens received from patients with varied clinical manifestations ranging from superficial infections, subcutaneous cysts, pneumonia, brain abscess to a disseminated infection. These specimens were processed in the Department of Microbiology for potassium hydroxide (KOH) examination and culture and in Pathology for cytology/histopathological examination (HPE). All specimens positive on direct examination for dark grey, brown or black fungi were included in the study. Results: A total of 20 specimens were confirmed as phaeohyphomycosis. Most of the patients belonged to the age group of 41 to 50 years. Male: Female ratio was 2.3:1. Trauma was the most common risk factor. Spectra of the isolated fungal pathogens comprised of Bipolaris species, Exophiala species, Curvularia geniculata, Phialemonium species, Daldinia eschscholtzii, Hypoxylon anthochroum, Phaeoacremonium species, Leptosphaerulina australis, Medicopsis romeroi, Lasiodiplodia theobromae, Eutypella species, Chaetomium globosum, Alternaria species, Cladophialophora bantiana and 2 unidentified dematiaceous fungi. Recovery from phaeohyphomycosis was seen in 12 patients, 7 were lost to follow up and one patient succumbed to the illness. Conclusion: Infections caused by phaeoid fungi can no longer be viewed as rare. In fact, phaeohyphomycosis can have myriad of presentations spanning from mild cutaneous infections to fatal brain disease. Therefore, a high index of clinical suspicion is needed to diagnose such infections. The primary treatment modality remains surgical removal of the lesion in cutaneous or subcutaneous infections however disseminated disease with a guarded prognosis requires aggressive management.

Fibrin Glue-Assisted Closure of Macroperforation in Predescemetic Deep Anterior Lamellar Keratoplasty With a Donor Obtained From Small Incision Lenticule Extraction.

PURPOSE: To report a case with multiple macroperforations and a double anterior chamber (AC) after predescemetic deep anterior lamellar keratoplasty. METHODS: A patient was referred after undergoing complicated excision of pseudopterygium that extended onto the cornea. At presentation, an eccentric lamellar patch graft extending over the pupillary axis with a double AC was seen. Surgical intervention showed a predescemetic plane of dissection with 2 macroperforations and iris plugging of the peripheral perforations. Suturing and fibrin glue alone did not seal the macroperforation, and a donor lenticule from small incision lenticule extraction (SMILE) was used to close the larger perforation using fibrin glue. A trephine was then used to mark a larger area of predescemetic dissection that included the original patch graft. A donor corneal graft was sutured after stripping Descemet membrane (DM). RESULTS: Postoperatively, the double AC resolved, and vision improved to 0.50 decimal equivalent (20/40) by 3 weeks. At 18-month postoperative follow-up, corrected distance visual acuity (CDVA) was 0.67 (20/30). The donor graft remained clear, and the SMILE lenticule with underlying sutures could be visualized. CONCLUSIONS: A donor lenticule from SMILE surgery is a useful adjunct to seal macroperforations in deep anterior lamellar keratoplasty because the thin uniform lamellar tissue is easily applied using fibrin glue and gives uniform and good apposition on both host and donor sides. It can be used immediately without further preparation unlike hand-fashioned patch grafts.