Candida Endophthalmitis After Descemet Stripping Automated Endothelial Keratoplasty With Grafts From Both Eyes of a Donor With Possible Systemic Candidiasis
| Autor: | Madhura Joag, Edgar M. Espana, Kavitha R. Sivaraman, Darlene Miller, Juan F. Batlle, Sonia H. Yoo, Carol L. Karp, Sotiria Palioura, Adam Sise, Guillermo Amescua, Anat Galor |
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| Rok vydání: | 2018 |
| Předmět: |
Male
0301 basic medicine Pars plana medicine.medical_specialty genetic structures medicine.medical_treatment 030106 microbiology Intraocular lens Article Keratitis 03 medical and health sciences 0302 clinical medicine Endophthalmitis Cornea Ophthalmology medicine Humans Fungal keratitis Aged Aged 80 and over business.industry Genetic strain Candidiasis Eye infection medicine.disease Tissue Donors eye diseases medicine.anatomical_structure 030221 ophthalmology & optometry sense organs business Eye Infections Fungal Descemet Stripping Endothelial Keratoplasty |
| Zdroj: | Cornea. 37:515-518 |
| ISSN: | 0277-3740 |
| Popis: | Purpose To report 2 cases with late postoperative Candida albicans interface keratitis and endophthalmitis after Descemet stripping automated endothelial keratoplasty (DSAEK) with corneal grafts originating from a single donor with a history of presumed pulmonary candidiasis. Methods Two patients underwent uncomplicated DSAEK by 2 corneal surgeons at different surgery centers but with tissue from the same donor and were referred to the Bascom Palmer Eye Institute with multifocal infiltrates at the graft-host cornea interface 6 to 8 weeks later, and anterior chamber cultures that were positive for the same genetic strain of C. albicans. Immediate explantation of DSAEK lenticules and daily intracameral and instrastromal voriconazole and amphotericin injections failed to control the infection. Thus, both patients underwent therapeutic penetrating keratoplasty with intraocular lens explantation, pars plana vitrectomy, and serial postoperative intraocular antifungal injection. Results Both patients are doing well at 2 years postoperatively with best-corrected vision of 20/20 and 20/30+ with rigid gas permeable lenses. One patient required repeat optical penetrating keratoplasty and glaucoma tube implantation 1 year after the original surgery. Literature review reveals that donor lenticule explantation and intraocular antifungals are often inadequate to control fungal interface keratitis, and a therapeutic graft is commonly needed. Conclusions Interface fungal keratitis and endophthalmitis due to infected donor corneal tissue is difficult to treat, and both recipients of grafts originating from the same donor are at risk of developing this challenging condition. |
| Databáze: | OpenAIRE |
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