Post-transplant Interface Infectious Keratitis

A patient with past ocular history of pseudoexfoliation syndrome, left eye Descemet’s Stripping Endothelial Keratoplasty (DSEK) and left eye scleral fixated intraocular lens after complicated left eye cataract surgery presented to the emergency room with left eye pain and decreased vision 3 months after left eye corneal transplantation. The patient’s exam was significant for left eye decreased visual acuity to 20/30 and a corneal exam with faint multifocal white infiltrates with feathery borders along the endothelium with extension into the stroma. Her corneal culture was positive for Candida Parapsilosis. She was started on topical Natamycin 5% and her symptoms improved while being followed by her outside ophthalmologist. She re-presented to Bascom Palmer 4 months later with worsening visual acuity and a worsening corneal infiltrate. Anterior segment optical coherence tomography showed a full thickness corneal infiltrate. Topical natamycin was increased and topical Amphotericin was started. The patient’s symptoms and exam continued to worsen on topical therapy. Repeat culture showed no growth. The patient is currently awaiting left eye therapeutic penetrating keratoplasty with intraocular lens removal.

Presentation Date: 09/16/2021

Issue Date: 10/08/2021