Dr.Puja Prativa Samantaray
A 60year old man with retinal vasculitis in both eyes was given posterior sub-tenon triamcinolone(PST) injection in right eye(RE).
One month after the injection, patient presented with complaints of pain and irritation for 10 days following dust fall in RE. He had corneal anterior stromal infiltrate with feathery margins. Whitish deposits were seen in the superotemporal subconjuctival space corresponding to the quadrant of PST injection given one month ago. Corneal scraping revealed fungal filaments on Gram’s stain and KOH mount.
Patient was started on topical natamycin and itraconazole .PST deposits in RE were evacuated surgically, following which the corneal ulcer responded to topical antifungals. Culture on potato dextrose agar grew Bipolaris species.
Conclusion: Long term persistence of triamcinolone deposits in the subconjunctival space is possible. Fungal Keratitis can be an unusual complication of PST injection which may necessitate evacuation of sub-tenon drug deposits.
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