Unusual case of Scedosporium apiospermum keratitis following phacoemulsification in a systemically well patient

We report the case of a 65-year-old immunocompetent woman who developed Scedosporium apiospermum keratitis after clear-corneal phacoemulsification. A 3.5 mm by 2.7 mm full-thickness stromal infiltrate, corresponding to the superior 2.75 mm clear-corneal incision, was observed 44 days postoperatively. Treatment included preservative-free voriconazole 1.0% hourly, ofloxacin 0.3% 6 times a day, oral voriconazole 200 mg once daily, natamycin 5.0% hourly, dexamethasone 0.1% 4 times a day, and ocular cyclosporine 4 times a day. After 4 months of treatment, the new vessels had regressed, the infiltrate had disappeared, and residual deep scarring remained; the uncorrected distance visual acuity was 0.8 logMAR. To our knowledge, this is the first case of S apiospermum keratitis following clear-corneal phacoemulsification. Another unusual feature is that there were no risk factors for fungal keratitis, specifically no history of trauma, systemic illness, immunosuppression, or contact lens wear.