Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Nov 29;85(6):565-571.
doi: 10.5935/0004-2749.20220059. eCollection 2021.

Infectious interface keratitis after Descemet membrane endothelial keratoplasty

Nesrin Tutas Gunaydin  1 , Burak Tanyıldız  1 , Baran Kandemir  1 , Saban Simsek  1
Affiliations

Infectious interface keratitis after Descemet membrane endothelial keratoplasty

Nesrin Tutas Gunaydin et al. Arq Bras Oftalmol. .

Abstract
in English, Portuguese

Purpose: To evaluate the clinical course and management of infectious interface keratitis after Descemet membrane endothelial keratoplasty.

Methods: A total of 352 cases that had undergone Descemet membrane endothelial keratoplasty were retrospectively reviewed. Patients with infectious interface keratitis during follow-up were analyzed. The microbiological analyses, time to infection onset, clinical findings, follow-up duration, treatment, and post-treatment corrected distance visual acuity were recorded.

Results: IIK was detected in eight eyes of eight cases. Three fungal and three bacterial pathogens were identified in all cases. All patients received medical treatment according to culture sensitivity. Antifungal treatment was initiated in two cases with no growth on culture, with a preliminary diagnosis of fungal interface keratitis. Intrastromal antifungal injections were performed in all patients with fungal infections. The median time to infection onset was 164 days (range: 2-282 days). The postoperative infectious interface keratitis developed in the early period in two cases. The mean follow-up duration was 13.4 ± 6.2 months (range: 6-26 months). Re-Descemet membrane endothelial keratoplasty was performed in two patients (25%) and therapeutic penetrating keratoplasty in four patients (50%) who did not recover with medical treatment. The final corrected distance visual acuity was 20/40 or better in five patients (62.5%).

Conclusion: The diagnosis and treatment of infectious interface keratitis following Descemet membrane endothelial keratoplasty are challenging. Early surgical intervention should be preferred in the absence of response to medical treatment. Better graft survival and visual acuity can be achieved with therapeutic penetrating keratoplasty and re-Descemet membrane endothelial keratoplasty in patients with infectious interface keratitis.

Objetivo: Avaliar o curso clínico e o manejo da ceratite infecciosa de interface após ceratoplastia endotelial da membrana de Descemet.

Métodos: Um total de 352 casos submetidos a ceratoplastia endotelial da membrana de Descemet foram revisados retrospectivamente. Pacientes com ceratite infecciosa de interface foram analisados durante o acompanhamento. As análises microbiológicas, o tempo até o início da infecção, os achados clínicos, a duração do acompanhamento, o tratamento e a acuidade visual para longe corrigida pós-tratamento foram registrados.

Resultados: Ceratite infecciosa de interface foi detectada em 8 olhos de 8 casos. Três patógenos fúngicos e três bacterianos foram identificados em todos os casos e receberam tratamento médico de acordo com a sensibilidade da cultura. O tratamento antifúngico foi iniciado em dois casos sem crescimento em cultura, com diagnóstico preliminar de ceratite infecciosa fúngica. Injeções antifúngicas intraestromais foram usadas em todos os casos com infecções fúngicas. O tempo médio para o início da infecção foi de 164 dias (variação: 2-282 dias). A ceratite infecciosa de interface pós-operatória desenvolveu-se no período inicial em dois casos. A duração média do acompanhamento foi de 13,4 ± 6,2 meses (variação: 6-26 meses). A ceratoplastia endotelial de membrana de Descemet foi realizada em dois casos (25%) e ceratoplastia penetrante terapêutica em quatro casos (50%) que não se recuperaram com tratamento médico. A acuidade visual para longe corrigida final foi de 20/40 ou melhor em 5/8 (62,5%) dos pacientes.

Conclusões: O diagnóstico e o tratamento da ceratite infecciosa de interface após ceratoplastia endotelial da membrana de Descemet são difíceis. A intervenção cirúrgica precoce deve ser o procedimento preferido se não houver resposta ao tratamento médico. Melhor sobrevida do enxerto e melhor acuidade visual podem ser alcançadas com ceratoplastia penetrante terapêutica e ceratoplastia endotelial da membrana de Descemet em pacientes com ceratite infecciosa de interface

PubMed Disclaimer

Conflict of interest statement

Disclosure of potential conflicts of interest: None of the authors have any potential conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Early fungal IK after DMEK. Patient 1: photograph 2 days after DMEK showing a single white interface spot (arrow).
Figure 2
Figure 2
Postoperative slit-lamp photograph of the same eye (patient 1 in Table 2) a few months after therapeutic penetrating keratoplasty showing a clear cornea.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Arenas E, Esquenazi S, Anwar M, Terry M. Lamellar corneal transplantation. Survey of ophthalmology. 2012;57(6):510–529. - PubMed
    1. Melles GRJ, San Ong T, Ververs B, van der Wees J. Descemet membrane endothelial keratoplasty (DMEK) Cornea. 2006;25(8):987–990. - PubMed
    1. Nahum Y, Russo C, Madi S, Busin M. Interface infection after descemet stripping automated endothelial keratoplasty: outcomes of therapeutic keratoplasty. Cornea. 2014;33(9):893–898. - PubMed
    1. Tu EY, Hou J. Intrastromal antifungal injection with secondary lamellar interface infusion for late-onset infectious keratitis after DSAEK. Cornea. 2014;33(9):990–993. - PubMed
    1. Kanavi MR, Foroutan AR, Kamel MR, Afsar N, Javadi MA. Candida interface keratitis after deep anterior lamellar keratoplasty: clinical, microbiologic, histopathologic, and confocal microscopic reports. Cornea. 2007;26(8):913–916. - PubMed

MeSH terms

Substances

LinkOut - more resources