Interface Fungal Keratitis Status Post DSAEK
Narrative Responses:
Purpose
To report a case of interface fungal keratitis post-DSAEK surgery.
Methods
Case report. A 59 year old female underwent combined phacoemulsification, insertion of an IOL, and DSAEK. Culture of the donor rim came back positive for Candida albicans. The first signs of fungal keratitis were apparent approximately 6 weeks post-operatively. The infiltrate was resistant to topical and intracameral amphotericin, topical voriconazole and oral Fluconazole. The patient required 2 intrastromal and intracameral injections of voriconazole and intravitreal amphotericin, continued topical and oral treatment, as well as removal of the donor lenticule.
Results
The donor lenticule was sent for culture and came back positive for Candida albicans. The patient gradually improved with the above treatment. The patient underwent a successful repeat DSAEK nine months after the initial surgery.
Conclusion
This case of interface fungal keratitis post-DSAEK demonstrates the importance of aggressive treatment, the need to remove the donor lenticule and the value of corneal donor rim culture. Review of the literature indicates this is the first reported case of successful repeat DSAEK post interface fungal keratitis.