Original ArticleIntroduction I nfective keratitis is an important cause of corneal blindness and fungal keratitis is a major subgroup accounting for around 30% of all cases. Fungal keratitis remains a diagnostic and therapeutic challenge to the ophthalmologist and is associated with significant ocular morbidity. Management remains a problem due to poor ocular penetration of antifungal drugs. We conducted a study to assess the efficacy of various drugs in keratomycosis, efficacy of surgical management and the final visual outcomes after combined medical and surgical management. Materials and MethodsTwenty five consecutive cases of keratomycosis reporting to our department were studied. Diagnosis was based on history of ocular trauma especially with organic matter, clinical signs more than symptoms, ulcers with feathery margins, satellite lesions and presence of convex hypopyon. Corneal scrapings were taken and stained with Grams, potassium hydroxide (KOH), lactophenol blue and inoculated onto blood agar and Sabouraud's medium. Only those cases were included whose laboratory samples were positive for fungal elements or fungal growth. Thereafter, antifungal drugs were instituted and patients were followed up for a period of minimum three months after recovery from infection. However, those managed surgically were followed up for one year.The corneal ulcers were classified into mild, moderate or severe depending upon degree of corneal involvement. Mild ulcers: <1/3rd superficial stromal involvement. Moderate ulcers: 1/3rd-2/3rd stromal involvement. Severe ulcers:>2/3rd stromal involvement, ulcer near limbus, impending perforation or perforated ulcers.Medical management included topical 5% natamycin drops, 1% itraconazole drops or 0.15% amphotericin B drops. The drops were instilled at 15 minute intervals for the first two hours, then hourly round the clock and then tapered off once clinical improvement occurred. Efficacy of medical management was assessed biomicroscopically by evaluating edge of infiltrate, density of suppuration, cellular infiltrate and oedema of surrounding stroma, and hypopyonThe cases with poor response to medical management, were taken up for surgery . Wherever possible anterior chamber paracentesis was done and 10 μgm of reconstituted amphotericin B in 0.1ml of 5% dextrose was injected into the anterior chamber. In patients with impending perforation or perforated cornea, therapeutic keratoplasty was done using fresh or preserved donor cornea and where required this was followed in turn by optical penetrating keratoplasty. In all cases donor corneal button with 0.5mm oversize was used. Postoperatively patients were kept on oral and topical antifungals with other supportive measures. ResultsOut of 25 patients studied, 19 (76%) were males and six (24%) were females. Eighteen (72%) belonged to a rural background and seven (28%) to an urban background. Twenty

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A case of tuberous sclerosis with the classical triad of adenoma sebaceum, mental retardation and epilepsy is reported in a 10 year old boy. Fundus examination revealed a typical "mulberry" tumour and cr scan showed multiple "brain-stones". Fundus examination as aid to early diagnosis is emphasized.