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.

Introduction: Silicone oil is the preferred tamponade agent used in pars-plana vitrectomy for retinal detachment when a long duration of endotamponade is intended. Due to its possible long-term complications, removal of silicone oil (ROO) is recommended. Purpose: This study is done to evaluate the mean duration and complications of silicone oil tamponade, and the anatomical and visual outcomes after silicone oil removal. Study design: Retrospective study. Materials and methods: Retrospective review was done on 55 eyes of 55 patients, in which ROO was carried out at Hospital Sultanah Bahiyah in 2016 with a minimum six months follow-up postoperatively. Results: The duration of silicone oil tamponade in these eyes ranged from 1.0 to 55.5 months, with mean duration of 10.8 months (SD 7.74). Common complications of silicone oil tamponade observed were cataract in 30 eyes (54.5%), followed by secondary high intraocular pressure in 6 eyes (10.9%), and band keratopathy in 3 eyes (5.5%). Six eyes (10.9%) developed retinal re-detachment after oil removal.  The majority in the anatomically attached group post ROO (40 eyes, 81.6%) showed improvement of vision after ROO, with mean best corrected vision of LogMAR 1.38 (6/150) with silicone oil in situ to LogMAR 0.88 (6/48) at the latest follow-up. Conclusions: Although the recommended duration of silicone oil tamponade ranges from three to six months, the optimal timing for silicone oil removal still remains unknown. ROO is recommended due to oil-related complications, but the anatomical outcome should be evaluated as well. However, in our setting, with limited resources and time, and increasing number of patients indicated for silicone oil, it is impossible to comply with the recommended time for ROO and the timing is usually set on an individual basis.