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

• Main Authors: Kenneth A. Beckman, Mark S. Milner, Parag A. Majmudar, Jodi I. Luchs
• Format: Article
• Language: English
• Published: Elsevier 2020-06-01
• Series: American Journal of Ophthalmology Case Reports
• Subjects: Fungal keratitis; Endothelial keratoplasty; Donor contamination; Donor culture
• Online Access: http://www.sciencedirect.com/science/article/pii/S2451993618305528

Purpose: To describe late-onset fungal keratitis after Descemet's stripping endothelial keratoplasty (DSEK) with positive fungal culture of the donor corneal rim. Observations: A 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 importance: A 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.