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Early Penetrating Keratoplasty after interface fungal keratitis in Descemet Membrane Endothelial Keratoplasty
Queratoplastia penetrante temprana después de queratitis fúngica de la interface en la queratoplastia endotelial de la membrana de Descemet
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Á. Sánchez-Ventosa, A. Cano-Ortiz, A. Villarrubia Cuadrado
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Instituto de Oftalmología la Arruzafa, Córdoba, Spain
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Received 10 April 2020. Accepted 29 May 2020
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Abstract

In this case-report we describe the first reported case of early-onset fungal interface keratitis (IK) after Descemet Membrane Endothelial Keratoplasty (DMEK) successfully treated with penetrating keratoplasty (PK) during the active stage of infection. A patient with graft failure after Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) was operated on with DMEK. Donor rim culture and broth were positive for Candida albicans. Several interface infiltrates were confirmed and localized using anterior segment optical coherence tomography. Three days after diagnosis, observing clear signs of intraocular infection, the graft was removed with simultaneous washed-up of anterior chamber with fluconazole 1% followed by a PK and intrastromal corneal injections of fluconazole. A best-corrected visual acuity of 20/20 was achieved. This case highlights the importance of analysing every donor rim and broth, despite the patient doesn’t show any symptoms or signs during the post-operative period. PK is a viable treatment option in early-onset interface keratitis.

Keywords:
Endothelial keratoplasty
Candida
Fungal interface keratitis
DMEK
Penetrating keratoplasty
Resumen

Este caso clínico describe el primer caso reportado de queratitis fúngica de la interfaz (QI) de inicio temprano después de una Queratoplastia Endotelial de la Membrana de Descemet (DMEK) tratadas satisfactoriamente con queratoplastia penetrante (QP) durante la etapa activa de la infección. Un paciente con fracaso de injerto después de una Queratoplastic Endotelial Automatizada con Pelado de Descemet (DSAEK) fue intervenido con DMEK. El cultivo y el medio de cultivo del donante dieron positivo para Candida albicans. Se confirmaron y localizaron varios infiltrados de la interface utilizando tomografía de coherencia óptica de segmento anterior. Tres días después del diagnóstico, observándose signos claros de infección intraocular, se retiró el injerto con lavado simultáneo de cámara anterior con fluconazol al 1% seguido de una QP e inyecciones corneales intraestromales de fluconazol. Se consiguió una mejor agudeza visual corregida de 20/20. Este caso resalta la importancia de analizar cada pieza y medio de cultivo de donantes a pesar de que el paciente no exhiba síntomas o signos durante el período posoperatorio. La QP es una opción de tratamiento viable para la queratitis de interface de inicio temprano.

Palabras clave:
Queratoplastia endotelial
Candida
Queratitis fúngica de la interface
DMEK
Queratoplastia penetrante

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