J Korean Ophthalmol Soc.  2008 Jul;49(7):1183-1188. 10.3341/jkos.2008.49.7.1183.

A Case of Fungal Endophthalmitis Developed Early After Penetrating Keratoplasty

• Lee H
• Song JS
• Kim HM

• KMID: 1476976
• DOI: http://doi.org/10.3341/jkos.2008.49.7.1183

Abstract

PURPOSE: To report a case of fungal endophthalmitis developed early after penetrating keratoplasty (PKP).
CASE SUMMARY
A 67-year-old man was diagnosed with cataract, bullous keratopathy, and Fuchs' dystrophy. He underwent phacoemulsification, posterior chamber intraocular lens implantation, and PKP. The preoperative visual acuity was counting fingers. One day after surgery, his visual acuity was 20/200, and there was no abnormal finding. In the afternoon, a slit lamp examination showed endothelial plaque and white materials in the anterior chamber, and ultrasonography revealed vitritis. A Gram stain and a KOH smear of donor corneoscleral rim, which was conducted during the operation, revealed yeast-like organisms. An intravitreal amphotericin B injection was performed, and topical and systemic amphotericin B were administered. The donor corneoscleral rim scraping grew Candida albicans on culture. Amphotericin B injection into the anterior chamber and anterior chamber irrigation were performed. The patient's vitritis worsened, so we performed pars plana total vitrectomy. Two months after treatment, the cornea showed complete clearing, and the endothelial cell density was 1779 cells/mm2 on noncontact specular microscopy. Five months after treatment, the final best corrected visual acuity was 20/20.
CONCLUSIONS
If a diagnosis of fungal endophthalmitis, which develops soon after PKP, is delayed, treatment could be very difficult. Culture of a donor corneoscleral rim may provide a guide to early diagnosis and successful treatment in cases of fungal endophthalmitis following PKP.

Keyword

Amphotericin B; Candida albicans; Fungal endophthalmitis; Penetrating keratoplasty

MeSH Terms

Aged
Amphotericin B
Anterior Chamber
Candida albicans
Cataract
Cornea
Early Diagnosis
Endophthalmitis
Endothelial Cells
European Continental Ancestry Group
Fingers
Fuchs' Endothelial Dystrophy
Humans
Keratoplasty, Penetrating
Lens Implantation, Intraocular
Microscopy
Phacoemulsification
Tissue Donors
Visual Acuity
Vitrectomy
Amphotericin B
Fuchs' Endothelial Dystrophy

Figure

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  Figure 1. (A) Preoperative anterior segment photograph shows severe corneal opacity and diffuse stromal edema. (B) Anterior segment photograph shows mild corneal edema and epithelial defect at one day after penetrating keratoplasty (PKP).

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  Figure 1. Anterior segment photograph shows round or fluffy white materials of various size in the anterior chamber at 2 days after PKP.

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  Figure 3. Gram stain which was conducted during operation at donor corneoscleral rim and preservation media shows yeast-like organisms.

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  Figure 4. Ultrasonograph shows heterogeneous vitreous opacity at 2 days after PKP.

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  Figure 5. Corneal transparency was completely recovered one month after PKP and 20 days after pars plana total vitrectomy.

Reference

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