From Fusarium solani Keratitis to Full Visual Acuity: A Case of Infection Requiring Multiple Corneal Transplants

Background and Clinical Significance: The Fusarium solani species complex is a group of filamentous fungi capable of causing severe ocular infections. It is a frequent cause of mycotic keratitis, which is associated with a poor prognosis due to aggressive biological behavior and resistance to most antifungal agents. Contact lens wear is a well-known risk factor; Case Presentation: A 48-year-old female contact lens wearer presented with a persistent corneal ulcer and hypopyon in the right eye. Initial visual acuity was hand movements. Hyphae of the Fusarium solani species complex were detected in an anterior chamber punctate sample. Intensive topical and systemic antifungal therapy was initiated, followed by therapeutic penetrating keratoplasty (PK) without corticosteroid treatment. Two months later, a second optical PK was performed. Over the subsequent two years, the patient underwent cataract surgery and developed endothelial corneal decompensation. During long-term follow-up, three Descemet membrane endothelial keratoplasties (DMEK) were required due to recurrent endothelial failures. Seven years after the initial presentation, the eye remained clinically stable with a best-corrected visual acuity of 0.0 logMAR; Conclusions: Early therapeutic PK without corticosteroid treatment was likely a key factor in successful infection control in this case of Fusarium solani keratitis. Full visual recovery can be achieved even after multiple penetrating and lamellar corneal transplantations in severe fungal keratitis.