Fungal keratitis is a dreaded occurrence in the cornea and anterior segment given the difficulty in treating the disease. Hereby reporting 5 cases of fungal keratitis causes by virulent organisms such as Aspergillus versicolor, Aspergillus fumigatus, Phialophora sp, and Fusarium sp. A retrospective interventional case series of 5 fungal keratitis which were successfully treated by intrastromal antifungal injection performed by a single surgeon from March 2017 till April 2018. The fungal keratitis stromal abscess sizes range from largest of 3mm x 2mm to smallest of 1mmx 1mm, mostly located paracentral and one case was noted to have hypopyon measuring about 1mm. On the first week of treatment, patients noted to exhibit poor response to topical antifungal. Hence, intrastromal amphotericin B injection 5mcg/0.1ml about 0.1ml administered into the affected eye ranging from once to 3 times in all patients except for one patient; who is post-operative 1 year penetrating keratoplasty infected with Phialophora keratitis is given intrastromal amphotericin B injection 5mcg/0.1ml about 0.1ml for 3 times and intrastromal voriconazole injection 50mcg/0.1ml about 0.1ml for 3 times. Within next four weeks, all the 5 cases of fungal keratitis became completely quiet with healed epithelial defect and corneal scarring. In summary, the intrastromal antifungal injection can constitute a good modality for the treatment of recalcitrant cases of fungal keratitis, revealing highly potent antifungal effects as the medication is administrated directly to the site of keratitis, promises shorter recovery period, and early intrastromal antifungal injection also leads to quicker healing with good vision prognosis.

Background: Chronic myeloid leukaemia (CML) presenting with only ocular manifestations either at the initial stage of diagnosis or at relapse is uncommon. We report two cases of CML presenting with isolated visual symptoms. Case series: The first case is a 21-year-old healthy gentleman who presented with left eye painless loss of vision for a one-week duration. Visual acuity was 6/60 in the left eye and 6/6 in the right eye. There were scattered retinal haemorrhages in both eyes and a sub-macular bleed over the left eye. The full blood count revealed a high white cell count of 134.6 × 10 9 /L. Peripheral blood smear showed hyper-leucocytosis with absolute eosinophilia and basophilia and the presence of blasts suggestive of CML thus chemotherapy was commenced. The second case is a 28-year-old in haematological, molecular, and cytogenic remission from CML for the past two years, presented with left eye painless vision loss for five days duration. Vision in the left eye was counting fingers. There was a large subretinal mass involving the left optic disc. Magnetic resonance imaging of the brain and orbit showed an elliptical orbital mass at the left globe posteriorly with diffuse thickening of the optic nerve. The patient was diagnosed as CML relapsed to the left optic nerve. He underwent intrathecal chemotherapy and orbital irradiation. Conclusion: Both these cases are unique since the manifestation of CML was with only ocular features at the time of presentation as per in the first case during the initial diagnosis and in the second case during relapse. This highlights that it is evident that the knowledge of ocular involvement in leukaemia is crucial since the eye is the only organ where leukemic infiltration to nerves and blood vessels can be observed directly. Recognizing fundus changes in leukaemia allows earlier diagnosis and prompt treatment. These case reports highlight the importance of recognizing early fundus changes, which should allow earlier diagnosis and treatment.

Keratomycosis is a significant cause of mono-ocular blindness, especially in tropical regions. Fungal keratitis developing in corneal incisions is very rare. We report the experience of treating two patients diagnosed with recalcitrant candida keratitis post-phacoemulsification with anterior chamber washout and deep debridement. The first patient was a 68-year-old woman who underwent left eye phacoemulsification nine months ago with a postoperative best corrected visual acuity of 6/6. The second patient was a 73-yearold man who had uneventful right eye phacoemulsification six months prior with a postoperative best corrected visual acuity of 6/9. Both patients used topical steroids postoperatively for more than three months and noted a drop in vision. Both patients had deep stromal infiltration and endothelial plaque at the primary corneal wound. They were unresponsive to topical, intracameral, and systemic antifungal therapy. Both patients underwent anterior chamber evacuation of hypopyon and endothelial plaque removal. Evacuation of hypopyon and removal of endothelial plaque was done with a 23G vitrectomy cutter using a low-powered vacuum controlled at 200 mmHg. The fluid inside the tubing was sent for culture analysis. We used viscoelastic coating on the endothelium to minimize the damage during the operations. Intracameral amphotericin B 15 µg/0.1 ml was given at the end of the operation. Postoperatively, both patients had clear corneas. The first patient's visual acuity improved 6/18, and the second patient's visual acuity improved to 6/9. Both cultures isolated Candida parapsilosis sensitive to amphotericin. These patient cases highlight that evacuation of the anterior chamber infiltration in recalcitrant fungal keratitis and intracameral injection of amphotericin B can be an effective adjuvant therapy.