Candida keratitis after Descemet stripping with automated endothelial keratoplasty

Purimse: To report a case of Candida albicans keratitis after Descemet stripping with automated endothelial keratoplasty (DSAEK) due to fungal contamination of the donor cornea. Methods: Case report. Results: A 73-year-old woman underwent phacoemulsification with intraocular lens 0014 implantation and DSAEK with 1 week difference. Ten days after DSAEK surgery, the culture of the donor comeoscleral rim revealed Candida albicans contamination and a small whitish infiltrate was noted within the interface. Despite conservative treatment with oral and systemic voriconazole, the infection was present outside the interface and inside the anterior chamber. Hot penetrating keratoplasty (PKP) was performed and the infection was eradicated. However, due to uncontrolled high intraocular pressure, a new PKP had to be performed, the IOL was removed, and an Ahmed valve was implanted (by pars plana vitrectomy). The anterior cap of the same donor cornea was used to perform a tectonic superficial anterior lamellar keratoplasty and the recipient did not have any problem related to fungal infection. Conclusions: The diagnosis of fungal keratitis should be taken into account once a small infiltrate is seen in the interface of any kind of lamellar keratoplasty. It is not clear whether it is better to treat it conservatively or aggressively.