Delayed Candida keratitis associated with Descemet's stripping endothelial keratoplasty
Abstract
Purpose: Our purpose is to report a unique case of Candida interface keratitis that remained quiescent for 3 years after Descemet's stripping endothelial keratoplasty (DSEK), within the endokeratoplasty graft itself, in a patient with underlying uveitis and local immunosuppression from a corticosteroid implant.
Methods: We describe a 20-year-old woman with a history of congenital glaucoma and secondary corneal edema who exhibited delayed worsening of fungal keratitis requiring treatment 3 years after a DSEK and concurrent fluocinolone acetonide intravitreal implantation.
Results: The patient was treated with topical, oral, and intrastromal antifungals without resolution of infection, necessitating a therapeutic penetrating keratoplasty. The corneal button showed Candida lusitaniae infection located between the posterior stroma and Descemet's membrane within the endokeratoplasty graft.
Conclusions: This report describes a case of late-developing fungal keratitis 3 years after DSEK that occurred in the graft itself, in the plane between the posterior stroma and Descemet's membrane, rather than between the donor and host cornea. This highlights the importance of maintaining a high index of suspicion for fungal keratitis in patients with persistent or worsening opacities in endothelial keratoplasty grafts.
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Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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