Late-onset fungal interface keratitis following endothelial keratoplasty with positive donor fungal culture

• Published in: American journal of ophthalmology case reports 2020, Vol.18, p.100707-100707
• Main Authors: Beckman, Kenneth A, Milner, Mark S, Majmudar, Parag A, Luchs, Jodi I
• Format: Report
• Language: English
• ISSN: 2451-9936
• DOI: 10.1016/j.ajoc.2020.100707

PURPOSETo describe late-onset fungal keratitis after Descemet's stripping endothelial keratoplasty (DSEK) with positive fungal culture of the donor corneal rim. OBSERVATIONSA case report of a patient undergoing DSEK is described whereby the donor corneal rim culture grew fungus. No infection was initially noted, but the patient developed fungal keratitis 1 year after the original DSEK procedure, despite prophylactic treatment at the time of the positive donor culture. The patient responded to antifungal therapy, but fungal keratitis recurred following completion of a 1-year course of antifungal treatment. The patient eventually underwent full thickness keratoplasty. CONCLUSIONS AND IMPORTANCEA positive fungal culture of the donor rim tissue at the time of endothelial keratoplasty is a risk factor for fungal keratitis. Even with prophylactic antifungal treatment, fungal keratitis may eventually develop as late as 1 year after the initial endothelial keratoplasty procedure. Treatment may need to be aggressive, but keratitis may recur despite resolution with antifungal treatment.