Ocular Microbiology and Immunology Group
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2016 OMIG Abstract 4

Rose Bengal-Mediated Photodynamic Antimicrobial Therapy: A Novel Adjunct Treatment for Resistant Fusarium Keratitis
Neda Nikpoor¹, Guillermo Amescua¹, Alejandro Arboleda², Heather Durkee², Nidhi Batra Relhan²,
Mariela C Aguilar², Harry W Flynn, Jr.¹, Darlene Miller^1,3, Jean-Marie Parel^2
1Anne Bates Leach Eye Hospital, ²Ophthalmic Biophysics Center, ³Ocular Microbiology Laboratory, Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL, USA

Purpose: To evaluate the effect of rose bengal-mediated photodynamic antimicrobial therapy (PDAT) for keratitis caused by multidrug-resistant Fusarium species.

Methods: Rose bengal-mediated PDAT using 0.1% rose bengal and exposure to 15-minute green light irradiation was performed for a patient with fungal keratitis at the Bascom Palmer Eye Institute after obtaining written informed consent from the patient.

Results: A 56 year old female patient with a history of penetrating keratoplasty for keratoconus presented to the Bascom Palmer Eye Institute with a central corneal ulcer and visual acuity of 20/400. Microbial work-up confirmed a Fusarium species. The infiltrate continued to expand to 3x3mm and threaten the host cornea despite good compliance with hourly natamycin 1% ophthalmic drops as well as oral fluconazole. After 4 weeks of treatment and worsening clinical picture, an intrastromal voriconazole injection was performed. Further microbial analysis and sequencing identified the organism as Fusarium keratoplasticum. Drug sensitivity testing using macrobroth dilution showed intermediate resistance to natamycin and high levels of resistance to amphotericin-B, voriconazole, and fluconazole. In vitro tests were performed to assess the susceptibility of the fungus isolated from patient’s cornea to rose bengal-mediated PDAT. The Fusarium isolate was completely inhibited by 0.1% rose bengal and 15-minute irradiation with a custom green LED light source. The corneal infiltrate continued to worsen and, given the progressive corneal melt and infection, PDAT was performed. One week after PDAT, the corneal infiltrate decreased in size and corneal epithelial defect decreased to 1x1mm; at this point all antifungal treatment was discontinued and another PDAT treatment was performed. The corneal thinning was halted and the patient’s pain and infiltrate resolved completely.

Conclusions: To our knowledge, this is the first patient treated with rose bengal-mediated PDAT for infectious keratitis. So far there has been no recurrence of the infection and no adverse events to report. These initial results of improved clinical outcome are promising. Rose bengal-mediated PDAT appears to be a potential treatment that could be considered for patients with non-resolving progressive, infectious keratitis caused by organisms resistant to standard treatment. This case study demonstrates proof of principle and further investigations need to be performed.

AAO Disclosure Code: N. Support: Edward D. and Janet K. Robson Foundation, Florida Lions Eye Bank, Drs. KR Olsen and ME Hildebrandt, NIH P30EY14801, Research to Prevent Blindness, Henri and Flore.

2016 Agenda and Abstracts | < Previous | Next >