Escleroqueratoplastia terapéutica sectorial de grosor completo en queratitis fúngica recurrente

espanolObjetivo Comunicar el manejo de una queratitis fungica recurrente severa, que requirio repetidas queratoplastias penetrantes. A pesar de los multiples tratamientos antifungicos topicos, intraoculares y sistemicos, una infiltracion micotica superotemporal repetidamente penetraba y descompensaba al trasplante corneal. Los cultivos preoperatorios y operatorios aislaron al mismo organismo, Fusarium spp. Discusion La infeccion corneal que se expande a la esclera o a las estructuras del angulo interno es la causa mas frecuente de recurrencia en la queratitis fungica despues del trasplante de cornea. En estos casos, la escleroqueratoplastia sectorial de grosor completo del sitio sospechoso de recurrencia, asociada a una queratoplastia penetrante central, deberia ser una tecnica quirurgica a considerar ya que permite una eliminacion definitiva de la infeccion con excelentes resultados de agudeza visual final. Ninguna complicacion postoperatoria ha sido registrada en este caso. EnglishObjective To report the management of a severe and recurrent fungal keratitis that required repeated penetrating keratoplasties. Despite multiple topical, intraocular and systemic antifungal treatments, superotemporal hyphal infiltration repeatedly penetrated the corneal transplant causing continuous recurrences. Cultures collected before and during surgery isolated the same organism, Fusarium spp. Conclusion Corneal infection extending to the sclera and internal angle structures is the main cause of recurrence of fungal keratitis after corneal transplantation. Sectorial full-thickness sclero-keratoplasty combined with a central penetrating keratoplasty should be a surgical technique to be considered in cases where these locations are suspected to be the source of recurrence. It enables a definitive elimination of the infection, with excellent final visual acuities. No postoperative complications were reported in this case.