Purulent Conjunctivitis and Progressive Corneal Stromal Necrosis

A 65-year-old man presents with right eye pain and purulent discharge. His medical history includes HIV managed by antiretroviral therapy. Examination of the right eye shows visual acuity of hand motions as well as purulent discharge, an inflamed conjunctiva, diffuse cornea opacification and thinning, and a flat anterior chamber. He has a 0.5-mm corneal perforation treated with corneal glue. He is treated with topical fortified vancomycin, tobramycin, intravenous levofloxacin, and doxycycline, but the purulent conjunctivitis and corneal stromal necrosis do not improve. What would you do next?
Source: JAMA Ophthalmology - Category: Opthalmology Source Type: research