Delayed Candida keratitis associated with Descemet's stripping endothelial keratoplasty.

PURPOSE: Our purpose is to report a unique case of Candida interface keratitis that remained quiescent for 3 years after Descemet's stripping endothelial keratoplasty (DSEK), within the endokeratoplasty graft itself, in a patient with underlying uveitis and local immunosuppression from a corticosteroid implant.

METHODS

We describe a 20-year-old woman with a history of congenital glaucoma and secondary corneal edema who exhibited delayed worsening of fungal keratitis requiring treatment 3 years after a DSEK and concurrent fluocinolone acetonide intravitreal implantation.

RESULTS

The patient was treated with topical, oral, and intrastromal antifungals without resolution of infection, necessitating a therapeutic penetrating keratoplasty. The corneal button showed Candida lusitaniae infection located between the posterior stroma and Descemet's membrane within the endokeratoplasty graft.

CONCLUSIONS

This report describes a case of late-developing fungal keratitis 3 years after DSEK that occurred in the graft itself, in the plane between the posterior stroma and Descemet's membrane, rather than between the donor and host cornea. This highlights the importance of maintaining a high index of suspicion for fungal keratitis in patients with persistent or worsening opacities in endothelial keratoplasty grafts.