J Korean Ophthalmol Soc.  2016 Jul;57(7):1170-1175. 10.3341/jkos.2016.57.7.1170.

A Case of Therapeutic Keratoplasty Using Cryo-preservative Cornea in Candida albicans Keratitis

• Han JY
• Jun JH

• KMID: 2317582
• DOI: http://doi.org/10.3341/jkos.2016.57.7.1170

Abstract

PURPOSE
To report a case treated with therapeutic keratoplasty using a cryo-preserved cornea in a patient with Candida albicans keratitis.
CASE SUMMARY
A 77-year-old female visited our clinic because of left ocular pain and visual disturbance for 3 days. Microscopic slit lamp examination revealed a 1.2 mm sized round corneal epithelial defect with deep stromal infiltration, brownish pigmentation and signs of inflammation with cyclitic membranes in the anterior chamber. On suspicion of Candida keratitis, we performed penetrating keratoplasty using a cryo-preserved donor cornea in Optisol-GS® (Bausch & Lomb, Irvine, CA, USA) solution with excision of the infected iris and colony of the anterior chamber. After the procedure, injection of intravitreal or intracameral amphotericin B and voriconazole were administered alternately. At 2 weeks after the second surgery, infection signs disappeared. At the follow-up in the outpatient clinic, signs of infection were not observed.
CONCLUSIONS
Therapeutic keratoplasty using a cryo-preserved donor cornea can be an immediate and effective therapeutic strategy for Candida albicans keratitis.

Keyword

Candida albicans; Cryopreserved cornea; Fungal keratitis; Therapeutic keratoplasty

MeSH Terms

Aged
Ambulatory Care Facilities
Amphotericin B
Anterior Chamber
Candida albicans*
Candida*
Cornea*
Corneal Transplantation*
Female
Follow-Up Studies
Humans
Inflammation
Iris
Keratitis*
Keratoplasty, Penetrating
Membranes
Pigmentation
Slit Lamp
Tissue Donors
Voriconazole
Amphotericin B
Voriconazole

Figure

• 

  Figure 1. Anterior segment photographs of the initial ophthalmic examination. (A) A 1.2 mm-sized thick and deep stromal infiltration with central brownish pigmentation (arrow). (B) Fluorescein staining revealed a round and well demarcated epithelial defect (arrowhead).

• 

  Figure 2. The serial surgical steps of therapeutic lamellar keratoplasty using a cryopreserved cornea. (A) Infected cornea was trephined with skin biopsy punch 3.0 mm in diameter. (B) Additionally, the infected cornea and visible inflamed tissues were removed. The dissected lesion is shown (arrow). (C) Lamellar dissection of cryopreserved cornea was performed using a crescent corneal blade (arrowhead). (D) A lamellar graft of the same diameter was positioned and sutured using 10–0 nylon.

• 

  Figure 3. The serial surgical step of therapeutic penetrating keratoplasty using a cryopreserved cornea. (A) Previous lamellar graft was infected and colonies of the Candida species spread to the iris and anterior surface of the crystalline lens. (B) The previous lamellar graft was trephined with skin biopsy punch 4.0 mm in diameter. (C) Status after full thickness keratectomy. Coagulum at anterior chamber (arrow) was observed. (D) Removal of coagulum using vannas scissors (arrowhead). (E) The full thickness cryopreserved corneal graft was obtained using the same-sized skin biopsy punch and sutured with 10–0 nylon. (F) A full thickness graft of the same diameter was positioned and sutured using 10–0 nylon.

• 

  Figure 4. Postoperative slitlamp photograph and anterior segment optical coherence tomography (OCT). (A) After 2 months, the corneal graft was well attached and no signs of a recurring infection were observed (arrowhead). (B) Anterior segment OCT at 2 months after the operation shows well attached corneal graft (between arrows) and slightly swollen epithelium. OS = oculus sinister.

Reference

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