Fungal blebitis due to Aspergillu ustus. About the first case described in the literature

• Published in: Acta ophthalmologica (Oxford, England) Vol. 100; no. S275
• Main Authors: Díaz‐Barreda, Mª. Dolores, Boned‐Murillo, Ana, Pinilla, Isabel, Rivasés, Guillermo Pérez, Fernández, Miguel Castillo, Pérez, Itziar, Pardina, Elena, Garcia, Diana Perez, Martinez, Juana, Ibañez, Juan
• Format: Journal Article
• Language: English
• Published: Malden Wiley Subscription Services, Inc 01.12.2022
• Subjects: Dyslipidemia; Glaucoma; Hyperuricemia
• ISSN: 1755-375X; 1755-3768
• DOI: 10.1111/j.1755-3768.2022.0742

Purpose: Blebitis is the infection of the valve created in glaucoma filtering surgery. Only 4 cases have been described that refer to ophthalmic infections caused by A. ustus, the pathogen demonstrated in the cultures in this case. Methods: We present the case of a 73‐year‐old woman with a history of hypertension, dyslipidaemia, hyperuricaemia, hypothyroidism and glaucoma in both eyes under maximum topical treatment, despite which she had elevated intraocular pressure (IOP) and structural progression in the right eye (RE). Trabeculectomy with mitomycin‐C (MMC) was performed in RE. After 36 days, the patient came to the emergency department with a slightly painful red and secretions in RE. Examination revealed a whitish bleb, hyperfiltration, fibrin in the anterior chamber and mild corneal oedema. The vitreous was not found to be involved at any time. A conjunctival swab was taken and treatment was started and the patient was admitted for blebitis 3 days later. Two anterior vitrectomies were necessary, the first with collection of aqueous humour (AH) samples and intravitreal injection of vancomycin, the second, after 3 weeks, with phacoemulsification (leaving the patient in aphakia), collection of AH and vitreous samples and intravitreal injection of voriconazole with the addition of oral fluconazole. Results: Eleven weeks after the first surgery Aspergilus ustus was isolated in vitreous humour samples. After 1 year of follow‐up the patient has visual acuity (VA) of light perception in RE, ptisis bulbi, hypotonia, without pain, discomfort, signs of infection or any other symptoms. Together with her it was decided to perform enucleation. Conclusions: Blebitis is a potentially fatal complication whose risk does not decrease over the years. Being alert to warning signs and symptoms is paramount for early detection and optimal management. To our knowledge this would be the first reported case of A. ustus blebitis.