Case Report : Navigating the uncommon: Medicopsis romeroi-induced corneal ulcer

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An early adolescence male, after recent corneal tear repair, presented acute eye pain, redness, and decreased vision for 1 day. He underwent corneal tear repair elsewhere post vegetative matter-related swimming injury. Ophthalmic examination revealed a 2.5*3.3mm ulcer around sutures. Corneal scrapings enabled microscopy and culture. With lesion worsening, tissue adhesive (TA) and bandage contact lens (BCL) were applied. Fungal culture identified Medicopsis romeroi. Patient's history, clinical course, and treatment were documented. Microscopy unveiled fungal hyphae, later confirmed as Medicopsis romeroi. Treatment included topical/systemic antifungals. Post-TA + BCL, significant improvement followed, with re-epithelialization, scarring. This report underscores the importance of considering rare fungal pathogens like Medicopsis romeroi in cases of corneal ulcers, especially in individuals with unusual risk factors. Timely diagnosis through microscopy and fungal culture, coupled with tailored antifungal treatment led to successful management and favorable patient outcomes. This case also emphasizes the significance of vigilant clinical observation, precise laboratory analysis, and multidisciplinary collaboration between ophthalmologists and microbiologists in managing atypical ocular infections." } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/13-764", "name": "Case Report : Navigating the uncommon: Medicopsis romeroi-induced..." } } ] } Home Browse Case Report : Navigating the uncommon: Medicopsis romeroi-induced... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Shetty PA, Vuyyuru S, Tara D and Bhalerao S. Case Report : Navigating the uncommon: Medicopsis romeroi-induced corneal ulcer [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2024, 13 :764 ( https://doi.org/10.12688/f1000research.152941.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Case Report Case Report : Navigating the uncommon: Medicopsis romeroi-induced corneal ulcer [version 1; peer review: 1 approved, 1 approved with reservations] Prerana A Shetty 1 , Sowjanya Vuyyuru 2 , Divya Tara 1 , Sushank Bhalerao 2 Prerana A Shetty 1 , Sowjanya Vuyyuru 2 , Divya Tara 1 , Sushank Bhalerao 2 PUBLISHED 08 Jul 2024 Author details Author details 1 MBBS, MS (Ophthalmology), Cornea Fellow, Shantilal Shanghvi Cornea Institute (SSCI), KVC campus, L V Prasad Eye Institute, Vijayawada, Andhra Pradesh, India., Vijayawada, Andhra Pradesh, 521137, India 2 MBBS, MS (Ophthalmology), Consultant, Shantilal Shanghvi Cornea Institute (SSCI), KVC campus, L V Prasad Eye Institute, Vijayawada, Andhra Pradesh, India., Vijayawada, Andhra Pradesh, 521137, India Prerana A Shetty Roles: Conceptualization, Methodology, Writing – Original Draft Preparation Sowjanya Vuyyuru Roles: Conceptualization, Data Curation, Investigation, Methodology, Validation, Writing – Review & Editing Divya Tara Roles: Conceptualization, Investigation, Methodology, Software, Writing – Original Draft Preparation Sushank Bhalerao Roles: Conceptualization, Funding Acquisition, Investigation, Methodology, Resources, Supervision, Validation, Writing – Original Draft Preparation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Eye Health gateway. Abstract Abstract* This report details a rare case of corneal infection caused by Medicopsis romeroi, highlighting clinical presentation, diagnostic methods, treatment, and outcome. An early adolescence male, after recent corneal tear repair, presented acute eye pain, redness, and decreased vision for 1 day. He underwent corneal tear repair elsewhere post vegetative matter-related swimming injury. Ophthalmic examination revealed a 2.5*3.3mm ulcer around sutures. Corneal scrapings enabled microscopy and culture. With lesion worsening, tissue adhesive (TA) and bandage contact lens (BCL) were applied. Fungal culture identified Medicopsis romeroi. Patient's history, clinical course, and treatment were documented. Microscopy unveiled fungal hyphae, later confirmed as Medicopsis romeroi. Treatment included topical/systemic antifungals. Post-TA + BCL, significant improvement followed, with re-epithelialization, scarring. This report underscores the importance of considering rare fungal pathogens like Medicopsis romeroi in cases of corneal ulcers, especially in individuals with unusual risk factors. Timely diagnosis through microscopy and fungal culture, coupled with tailored antifungal treatment led to successful management and favorable patient outcomes. This case also emphasizes the significance of vigilant clinical observation, precise laboratory analysis, and multidisciplinary collaboration between ophthalmologists and microbiologists in managing atypical ocular infections. READ ALL READ LESS Keywords fungal keratitis; rare fungus; natamycin; tissue adhesive; bandage contact lens Corresponding Author(s) Sushank Bhalerao ( [email protected] ) Close Corresponding author: Sushank Bhalerao Competing interests: No competing interests were disclosed. Grant information: Hyderabad Eye Institute and Hyderabad Eye Research Foundation (2024-06) The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2024 Shetty PA et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Shetty PA, Vuyyuru S, Tara D and Bhalerao S. Case Report : Navigating the uncommon: Medicopsis romeroi-induced corneal ulcer [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2024, 13 :764 ( https://doi.org/10.12688/f1000research.152941.1 ) First published: 08 Jul 2024, 13 :764 ( https://doi.org/10.12688/f1000research.152941.1 ) Latest published: 08 Jul 2024, 13 :764 ( https://doi.org/10.12688/f1000research.152941.1 ) Introduction Fungal keratitis typically results from the external acquisition of fungal agents, usually resulting from the traumatic implantation of fungal fragments or spores into the cornea. Notably, plant debris-related injuries account for a substantial 60% of fungal keratitis cases, making them the predominant causative mechanism. Fungal keratitis can be attributed to a spectrum of cornea-pathogenic fungi. These include species within the genera Fusarium, Aspergillus, Candida, Curvularia, and Penicillium. The prevalence of these fungi may vary based on geographical, occupational, and host-specific factors. Nevertheless, several fungal species are consistently detected as a cause of keratitis. 1 An emergent pathogen Medicopsis romeroi is allocated to phylum Ascomycota according to National Center for Biotechnology Information. These organisms are widely distributed in the soil and plants, and they are able to infect people by direct inoculation. It is an emerging fungus causing subcutaneous phaeohyphomycosis. It has mostly been reported in immunocompromised patients receiving immunosuppressive drugs for hematologic malignancy, renal transplantation, rheumatoid arthritis, leprosy, and asthma; however, there has been one report of a healthy, immunocompetent host. 2 Comprehensive discussions about Medicopsis romeroi are lacking in existing medical literature. Therefore, this case report aims to shed light on the clinical features and management strategies employed in a case of corneal ulcer caused by Medicopsis romeroi. Case report A male in his late teens presented to cornea clinic with complaints of redness, pain and decreased vision in his left eye. He had undergone corneal tear repair elsewhere after trauma with vegetative matter while swimming. At the time of presentation, his visual acuity was 20/20 in right eye and counting finger at 1 metre in the left eye. Upon detailed examination using slit lamp biomicroscopy, we observed a sutured corneal tear which was surrounded by a 2.5*3.3mm full thickness corneal infiltrate. [ Figure. 1a ] In order to assess the status of the posterior segment, a B-scan ultrasound was conducted, which showed no evidence of posterior segment involvement. Figure 1. a) Slit-lamp image showing intact sutures and corneal infiltrate at presentation, b) Slit-lamp image showing worsening of infiltrate and shallowing of anterior chamber. Corneal scraping was done, and the obtained material was then prepared with potassium hydroxide (KOH) for microscopic examination, which unveiled septate fungal filaments. The patient was treated with natamycin 5% eyedrops, administered hourly, coupled with oral ketoconazole 200mg twice a day and cycloplegics. Further the material was cultured but did not grow and organisms. Worsening was noted with the infiltrate increasing in size and severity and anterior chamber (AC) leak was noted. [ Figure 1b ] Repeat corneal scraping with AC reformation, TA and BCL was done. Topical Voriconazole 1% drops was added to the treatment. This time the culture revealed significant growth of dematiaceous fungi which was later identified as medicopsis romeroi. Over four months, there was significant improvement with scar formation with vascularization. [ Figure. 2 ] Visual acuity also improved to 20/80. Corneal topography followed by contact lens trial was conducted, and the patient accepted the lens, improving vision to 20/100. [ Figure 3a ] Anterior segment OCT was done which revealed dense stromal scar tissue along the full thickness and he also developed an anterior capsular opacification in the visual axis. [ Figure 3b ] Synechiolysis was performed to release the anterior synechiae formed. The visual acuity improved to 20/50 and in view of zonular dialysis, pars plana lensectomy was planned. Figure 2. a) Tissue adhesive applied after perforation noted, b) Consolidation of infiltrate with peripheral vascularization, c) Resolving infiltrate with vascularization, d, e, f) Scar tissue formation with resolution of infiltrate during the follow up period at 1, 2 and 4 months respectively. Figure 3. a) Oculyzer topography image at 4 months prior to contact lens fitting, b) Full thickness scar tissue on anterior segment OCT. Discussion In the presented case, our patient was diagnosed with fungal keratitis caused by Medicopsis romeroi, highlighting the persistent challenge of fungal keratitis as a leading cause of visual impairment in developing nations. An understanding of the regional epidemiological features, risk factors, and etiological agents is important in the prevention and appropriate management of this disease entity. 3 Fungal keratitis manifests in two primary presentations: filamentous fungal keratitis and yeast-like fungal keratitis. Filamentous fungal keratitis encompasses a spectrum of potential pathogens, including Fusarium, Aspergillus, Curvularia, Scedosporium apiospermum, Phaeohyphomycetes, and Paecilomyces. Identified risk factors for fungal keratitis encompass corneal trauma, contamination with plant material, immunosuppression, contact lens-related trauma, corneal surgery, and chronic keratitis. Diagnosis of fungal keratitis is traditionally established through culture techniques involving blood agar, Sabouraud agar, or brain–heart infusion broth, with corneal biopsy yielding a positive organism isolation rate of up to 82%. 4 Dematiaceous fungi, also referred to as melanized fungi, derive their dark pigmentation from the presence of melanin within the hyphal cell wall. More than 150 species and 70 genera of dematiaceous fungi have been implicated in human or animal diseases, and the list is expanding due to advances in the techniques applied to modern taxonomy. Dematiaceous fungi are primarily saprophytic, commonly inhabiting soil and plant environments. While they infrequently cause clinical disease, their significance as pathogens becomes pronounced, particularly in immunocompromised individuals. 5 M. romeroi (formerly Pyrenochaeta romeroi), belongs to the saprophytic dematiaceous fungi and is classified within the order Pleosporales and the class Coelomycetes. These filamentous fungi are distinguished by their production of conidia within specialized fruiting structures called pycnidia. Coelomycetes are known to cause various superficial or subcutaneous infections, including onychomycosis, subcutaneous phaeohyphomycosis (PHM), and eumycetoma. They exhibit a wide geographic distribution, commonly thriving in soil and plants, particularly in tropical and subtropical regions, with the capacity to infect humans through direct inoculation into the skin. Human cases of M. romeroi infections are rare and primarily manifest as subcutaneous PHM or black grain eumycetoma. 6 Regardless of the clinical manifestation, the most common approach to management of M. romeroi infection was treatment with azole antifungals along with surgical excision. The challenge lies in the fact that most azole antifungals have shown a relatively high failure rate in the face of M. romeroi. It is unclear which antifungal is the drug of choice, whereas the low reported minimum inhibitor concentrations and favourable side effect profile of voriconazole support its use against M. romeroi 7 In the secondary analysis of the mycotic ulcer treatment trial II, the presence of hypopyon at baseline was associated with a 2.3-fold increase in the odds ratio of needing TPK. However, our patient did not present with hypopyon, neither at diagnosis nor at follow-up, and, no surgical procedure except TA+BCL with AC reformation was necessary for the resolution of the fungal infection, demonstrating inactivity after four months of follow-up. 1 , 8 Consent Written informed consent for the publication of the case report and any associated images was obtained from the patient prior to submission. Ethics and consent Ethical approval and consent were not required. Data availability No data are associated with this article. Acknowledgements None References 1. Sáenz-Madrazo N, Baeza A, Guinea J, et al. : First report of neocucurbitaria unguis-hominis keratitis. Journal of Fungi. 2022; 9 : 8. PubMed Abstract | Publisher Full Text | Free Full Text 2. Chanyachailert P, Leeyaphan C, Bunyaratavej S, et al. : Subcutaneous phaeohyphomycosis from Medicopsis Romeroi in a diabetic patient. Medical Mycology Case Reports. 2019; 26 : 69–72. PubMed Abstract | Publisher Full Text | Free Full Text 3. Gopinathan U, Garg P, Fernandes M, et al. : The epidemiological features and laboratory results of fungal keratitis. Cornea. 2002; 21 : 555–559. Publisher Full Text 4. Lakshmi S, Garcia CV: Recalcitrant Paecilomyces keratitis. BMJ Case Rep. 2019; 12 : e229226. PubMed Abstract | Publisher Full Text | Free Full Text 5. Los-Arcos I, Royuela M, Martín-Gómez MT, et al. : Phaeohyphomycosis caused by medicopsis romeroi in solid organ transplant recipients: Report of two cases and comprehensive review of the literature. Transpl. Infect. Dis. 2019; 21 : e13072. PubMed Abstract | Publisher Full Text 6. Aljundi M, Brun S, Akhoundi M, et al. : Recurrent subcutaneous phaeohyphomycosis due to Medicopsis romeroi: A case report in a dermatomyositis patient and review of the literature. Microorganisms. 2022; 11 : 3. PubMed Abstract | Publisher Full Text | Free Full Text 7. Garofalo F, Wilcock J, Lahey T: Posttraumatic endophthalmitis caused by Medicopsis Romeroi. Infect. Dis. Clin. Pract. 2022; 30 . Publisher Full Text 8. Prajna NV, Krishnan T, Rajaraman R, et al. : Predictors of Corneal Perforation or Need for Therapeutic Keratoplasty in Severe Fungal Keratitis: A Secondary Analysis of the Mycotic Ulcer Treatment Trial II. JAMA Ophthalmol. 2017; 135 : 987–991. PubMed Abstract | Publisher Full Text | Free Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 08 Jul 2024 ADD YOUR COMMENT Comment Author details Author details 1 MBBS, MS (Ophthalmology), Cornea Fellow, Shantilal Shanghvi Cornea Institute (SSCI), KVC campus, L V Prasad Eye Institute, Vijayawada, Andhra Pradesh, India., Vijayawada, Andhra Pradesh, 521137, India 2 MBBS, MS (Ophthalmology), Consultant, Shantilal Shanghvi Cornea Institute (SSCI), KVC campus, L V Prasad Eye Institute, Vijayawada, Andhra Pradesh, India., Vijayawada, Andhra Pradesh, 521137, India Prerana A Shetty Roles: Conceptualization, Methodology, Writing – Original Draft Preparation Sowjanya Vuyyuru Roles: Conceptualization, Data Curation, Investigation, Methodology, Validation, Writing – Review & Editing Divya Tara Roles: Conceptualization, Investigation, Methodology, Software, Writing – Original Draft Preparation Sushank Bhalerao Roles: Conceptualization, Funding Acquisition, Investigation, Methodology, Resources, Supervision, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information Hyderabad Eye Institute and Hyderabad Eye Research Foundation (2024-06) The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Article Versions (1) version 1 Published: 08 Jul 2024, 13:764 https://doi.org/10.12688/f1000research.152941.1 Copyright © 2024 Shetty PA et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Shetty PA, Vuyyuru S, Tara D and Bhalerao S. Case Report : Navigating the uncommon: Medicopsis romeroi-induced corneal ulcer [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2024, 13 :764 ( https://doi.org/10.12688/f1000research.152941.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 08 Jul 2024 Views 0 Cite How to cite this report: Sharma S. Reviewer Report For: Case Report : Navigating the uncommon: Medicopsis romeroi-induced corneal ulcer [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2024, 13 :764 ( https://doi.org/10.5256/f1000research.167757.r317902 ) The direct URL for this report is: https://f1000research.com/articles/13-764/v1#referee-response-317902 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 24 Sep 2024 Savitri Sharma , L. V. Prasad Eye Institute, Banjara Hills,, India Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.167757.r317902 This case report describes a rare cause of fungal keratitis- Medicopsis romeroi . While the clinical descriptions are well presented and well documented, the fungal characteristics are missing. Laboratory processing of the corneal scrapings is poorly described and the reader does not ... Continue reading READ ALL This case report describes a rare cause of fungal keratitis- Medicopsis romeroi . While the clinical descriptions are well presented and well documented, the fungal characteristics are missing. Laboratory processing of the corneal scrapings is poorly described and the reader does not get to learn the fungal characteristics that were used to identify the fungus nor is there any confirmatory test done. Some of the expressions are unusual, for example "Microscopy unveiled ...........romeroi " in line 8 in abstract. It is not clear whether it refers to initial microscopy of corneal scraping or microscopy of culture isolate for identification. Introduction requires references for some of the statements. All organisms must be written in italics. Photo-documentation of the corneal scraping microscopy as well as culture are required towards evidence supporting the diagnosis of the case. Language needs greater care. The line 11 sentence- "Further..........organisms " in case report is incomplete that conveys no meaning. It is not clear how the second sample was processed. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? No Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? No Is the case presented with sufficient detail to be useful for other practitioners? No Competing Interests: No competing interests were disclosed. Reviewer Expertise: Ocular Microbiology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Sharma S. Reviewer Report For: Case Report : Navigating the uncommon: Medicopsis romeroi-induced corneal ulcer [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2024, 13 :764 ( https://doi.org/10.5256/f1000research.167757.r317902 ) The direct URL for this report is: https://f1000research.com/articles/13-764/v1#referee-response-317902 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Ghaith AA. Reviewer Report For: Case Report : Navigating the uncommon: Medicopsis romeroi-induced corneal ulcer [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2024, 13 :764 ( https://doi.org/10.5256/f1000research.167757.r310014 ) The direct URL for this report is: https://f1000research.com/articles/13-764/v1#referee-response-310014 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 09 Sep 2024 Alaa Atef Ghaith , Department of Ophthalmology, Faculty of Medicine, Alexandria Main University Hospital, Alexandria University, Alexandria, Egypt Approved VIEWS 0 https://doi.org/10.5256/f1000research.167757.r310014 This case report importance stems from the rarity of this fungal keratitis ( Medicopis romeroi ). It is an addition to our knowledge of new fungal species that can infect the cornea. The management of the case using tissue adhesive and bandage ... Continue reading READ ALL This case report importance stems from the rarity of this fungal keratitis ( Medicopis romeroi ). It is an addition to our knowledge of new fungal species that can infect the cornea. The management of the case using tissue adhesive and bandage contact lens upon leakage from the AC is controversial as it is not advised to place a contact lens on an infected corneal lesion. Also, the final photo of the corneal vascularized scar after 4 months is not correlated with the visual acuity of 20/80. However, the case was presented in sufficient details regarding the history, clinical findings, progress, treatment and final outcome. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the case presented with sufficient detail to be useful for other practitioners? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: I am a cornea and external eye disease consultant with expertise in the medical and surgical management of corneal disorders. I am a professor of Ophthalmology at the faculty of Medicine - Alexandria University - Egypt. I have a long history in the management of infectious keratitis in this facility and a number of publications in this field I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Ghaith AA. Reviewer Report For: Case Report : Navigating the uncommon: Medicopsis romeroi-induced corneal ulcer [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2024, 13 :764 ( https://doi.org/10.5256/f1000research.167757.r310014 ) The direct URL for this report is: https://f1000research.com/articles/13-764/v1#referee-response-310014 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 08 Jul 2024 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 1 08 Jul 24 read read Alaa Atef Ghaith , Alexandria Main University Hospital, Alexandria University, Alexandria, Egypt Savitri Sharma , L. V. Prasad Eye Institute, Banjara Hills,, India Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Sharma S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 24 Sep 2024 | for Version 1 Savitri Sharma , L. V. Prasad Eye Institute, Banjara Hills,, India 0 Views copyright © 2024 Sharma S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This case report describes a rare cause of fungal keratitis- Medicopsis romeroi . While the clinical descriptions are well presented and well documented, the fungal characteristics are missing. Laboratory processing of the corneal scrapings is poorly described and the reader does not get to learn the fungal characteristics that were used to identify the fungus nor is there any confirmatory test done. Some of the expressions are unusual, for example "Microscopy unveiled ...........romeroi " in line 8 in abstract. It is not clear whether it refers to initial microscopy of corneal scraping or microscopy of culture isolate for identification. Introduction requires references for some of the statements. All organisms must be written in italics. Photo-documentation of the corneal scraping microscopy as well as culture are required towards evidence supporting the diagnosis of the case. Language needs greater care. The line 11 sentence- "Further..........organisms " in case report is incomplete that conveys no meaning. It is not clear how the second sample was processed. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? No Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? No Is the case presented with sufficient detail to be useful for other practitioners? No Competing Interests No competing interests were disclosed. Reviewer Expertise Ocular Microbiology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Sharma S. Peer Review Report For: Case Report : Navigating the uncommon: Medicopsis romeroi-induced corneal ulcer [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2024, 13 :764 ( https://doi.org/10.5256/f1000research.167757.r317902) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-764/v1#referee-response-317902 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Ghaith A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 09 Sep 2024 | for Version 1 Alaa Atef Ghaith , Department of Ophthalmology, Faculty of Medicine, Alexandria Main University Hospital, Alexandria University, Alexandria, Egypt 0 Views copyright © 2024 Ghaith A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This case report importance stems from the rarity of this fungal keratitis ( Medicopis romeroi ). It is an addition to our knowledge of new fungal species that can infect the cornea. The management of the case using tissue adhesive and bandage contact lens upon leakage from the AC is controversial as it is not advised to place a contact lens on an infected corneal lesion. Also, the final photo of the corneal vascularized scar after 4 months is not correlated with the visual acuity of 20/80. However, the case was presented in sufficient details regarding the history, clinical findings, progress, treatment and final outcome. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the case presented with sufficient detail to be useful for other practitioners? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise I am a cornea and external eye disease consultant with expertise in the medical and surgical management of corneal disorders. I am a professor of Ophthalmology at the faculty of Medicine - Alexandria University - Egypt. I have a long history in the management of infectious keratitis in this facility and a number of publications in this field I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Ghaith AA. Peer Review Report For: Case Report : Navigating the uncommon: Medicopsis romeroi-induced corneal ulcer [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2024, 13 :764 ( https://doi.org/10.5256/f1000research.167757.r310014) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-764/v1#referee-response-310014 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Adjust parameters to alter display View on desktop for interactive features Includes Interactive Elements View on desktop for interactive features Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. 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