Successful treatment of deep corneal abscess with serial intrastromal broad-spectrum antibiotic injection: Case report and literature review

Purpose: To report the case of a male with a deep stromal corneal abscess recalcitrant to topical treatment who presented complete resolution after serial intrastromal broad-spectrum antibiotics injections. Observations: A 66 years old man with a medical history of type 1- neurofibromatosis presented with a 1 1-month history of painful vision loss in his right eye. Ophthalmological examination showed a deep limbal corneal abscess with hypopyon, with a best corrected visual acuity of hand movements. The abscess was refractory to complete topical treatment. He underwent 4 interventions with intrastromal injections of 1mg/0.1ml vancomycin and ceftazidime with 15-day intervals each one, associated anterior chamber washout. A complete resolution of infection was established due to clinical and paraclinical improvement evidenced in serial anterior chamber tomographies. Conclusion: Treatment of bacterial deep corneal abscess is challenging because of the limited treatment options. There is a lack of evidence about standardized doses of intrastromal injection of antibiotics. Keywords: Case report, corneal abscess, intrastromal injections