A case of fungal keratitis and endophthalmitis post penetrating keratoplasty resulting from fungal contamination of the donor cornea

Abstract

Purpose: Fungal infections post keratoplasty due to contamination of the donor corneal graft have become important issues that need to be addressed. Here we report a case of fungal keratitis and endophthalmitis post penetrating keratoplasty (PKP) due to fungal contamination of the donor corneal graft.

Observations: We present a 52-year-old male who underwent PKP with a donor corneal graft that was later found to be contaminated with fungus. At 4-weeks postoperative, infectious infiltrates suddenly appeared at the border between the host and donor corneal graft, and endophthalmitis concomitantly occurred. A culture of the remnant donor corneoscleral rims and the vitreous fluid obtained during vitreous surgery was found to be positive for Candida albicans. At 6-months post vitreous surgery and intensive anti-fungal medical treatment, both corneal infiltrates and vitreous opacity completely disappeared, and the patient's best-corrected visual acuity recovered to 20/40, with a transparent cornea.

Conclusions and importance: The findings of this case show that prompt intensive medical treatment and surgical intervention effectively saved the vision in a patient with fungal keratitis and endophthalmitis due to contamination of the donor corneal graft.

Keywords: Candida albicans; Contamination; Donor cornea; Fungal endophthalmitis; Fungal keratitis; Penetrating keratoplasty.

Fig. 1

Images of the patient's right eye at the time of undergoing penetrating keratoplasty. A, A white opacity (white arrow) which resembled infectious infiltrates was observed on the donor corneal graft, so this graft was removed and not used for the transplantation. B, Instead, a donor corneal graft was prepared from the contralateral eye of the same donor and used for the transplantation.

Fig. 2

Slit-lamp examination, retinal fundus, and B-scan ultrasound images. A-C, slit-lamp examination (A), retinal fundus (B), and B-scan ultrasound (C) images of the patient's right eye prior to undergoing vitrectomy on November 9, 2015. Small white infiltrates (white arrow in A) were observed at the border between the host and donor corneal graft. Retinal fundus and B-scan ultrasound examinations revealed a vitreous opacity. D and E, slit-lamp examination (D) and retinal fundus (E) images of the patient's right eye post intensive treatment (D: slit-lamp image taken on May 10, 2016; E: retinal fundus image taken on December 11, 2015). As can be seen in the images, the white infiltrates on the cornea and vitreous opacity had completely disappeared.

Fig. 3

Summary of the intensive treatment. A: Intravitreous injection of vancomycin and ceftazidime (1st time), B: Intravitreous injection of vancomycin and ceftazidime (2nd time), C: Vitrectomy.