Fungal Interface Keratitis After Descemet Membrane Endothelial Keratoplasty.

Abstract:

PURPOSE:To evaluate the incidence, clinical course, and management of fungal interface keratitis (IK) after Descemet membrane endothelial keratoplasty (DMEK). METHODS:This is a single-center retrospective observational case series of 3950 eyes undergoing DMEK. Six eyes with fungal IK were detected and analyzed. Analysis included graft storage condition, incidence of fungal IK, identification of the pathogenic agent, topical/systemic and surgical treatment regimen, and best-corrected visual acuity. RESULTS:Fungal IK after DMEK occurred in 6 of 3950 cases (0.15%). Corneal grafts were either stored in Optisol-GS (n = 4) or in organ culture (n = 2). In all cases, Candida species were isolated (Candida tropicalis, Candida albicans, Candida orthopsilosis, and Candida guilliermondii). Four eyes developed fungal IK during the early postoperative period (3-5 d) and 2 eyes later at 16 to 42 days after surgery. All patients received topical and systemic antifungal treatment and intracameral application of antifungal agents. In the case of an early infection, graft removal was performed in 3 of 4 patients. Late infections were eradicated without graft exchange. Recurrence of fungal infection was observed in 1 case after early IK and in both cases after late IK. Final visual acuity ranged from 20/200 to 20/20. CONCLUSIONS:Fungal IK is a rare complication after DMEK. Based on our experience, we believe that treatment of early fungal IK with aggressive presentation should include both immediate graft exchange and intracameral application of voriconazole and amphotericin, in addition to topical and systemic antifungal treatment. Graft exchange seems not to be mandatory in late infections.

journal_name

Cornea

journal_title

Cornea

authors

Augustin VA,Weller JM,Kruse FE,Tourtas T

doi

10.1097/ICO.0000000000001727

subject

Has Abstract

pub_date

2018-11-01 00:00:00

pages

1366-1369

issue

11

eissn

0277-3740

issn

1536-4798

journal_volume

37

pub_type

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