amphotericin-b and Keratoconus

To report the clinical, histopathologic, microbiologic, and confocal microscopic features of Candida keratitis after deep anterior lamellar keratoplasty (DALK).. We performed clinical, confocal scan, microbiologic and histopathologic examinations on two corneas from 2 young patients who underwent DALK for keratoconus.. The first patient presented with asymptomatic white to cream-colored interface deposits 2 months after DALK. The confocal scan disclosed clusters of hyperreflective, fine granular deposits at the region of interface, with no evidence of inflammation or hyphaelike structures. The clinical presumption of possible "epithelial downgrowth" was suggested, and because of the progression of these lesions, irrigation of the interface was considered. Finally, penetrating keratoplasty was performed because of a rupture in the Descemet membrane. Histopathologic examination of the cornea disclosed yeastlike structures within the interface area. The microbiologic results of the irrigation fluid showed Candida glabrata. The second patient presented with a symptomatic infiltration of the inferior interface close to the suture site 2.5 months after DALK. The confocal scan showed foci of inflammation with clusters of hyperreflective round-shaped structures that resembled epithelial cells. Clinically, there was a suggestion of epithelial downgrowth, and subsequently, penetrating keratoplasty was performed because of the progression of the lesion. Histopathologic examination of the cornea disclosed an acute and chronic granulomatous keratitis caused by yeastlike structures. The microbiologic results revealed infection with Candida albicans.. These are the first reported occurrences of interface Candida keratitis after DALK and with different confocal features. The clinical and the confocal features of interface Candida keratitis may be similar to those seen in epithelial downgrowth, which may postpone correct diagnosis and treatment. Candida keratitis should be considered in cases of interface deposits after any form of lamellar keratoplasty.

Topics: Adult; Amphotericin B; Antifungal Agents; Candida albicans; Candida glabrata; Candidiasis; Cornea; Corneal Transplantation; Drug Therapy, Combination; Eye Infections, Fungal; Humans; Keratitis; Keratoconus; Keratoplasty, Penetrating; Ketoconazole; Male; Microscopy, Confocal; Natamycin; Postoperative Complications

To report donor-to-host transmission of Candida albicans after penetrating keratoplasty.. Interventional case report.. A 15-year-old boy who underwent penetrating keratoplasty for keratoconus with donor tissue from a drowning victim developed keratitis and a lenticular abscess 26 days postoperatively.. Candida albicans was cultured from the donor rim and the recipient cornea. Antifungal sensitivity profiles were identical for the two isolates. DNA profiles were identical for both isolates, confirming the donor as the source of the infection.. This case demonstrates the value of routine culture of corneal donor rims and the advisability of close follow-up and possible antifungal prophylaxis when donor rims are positive for fungus.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis; Combined Modality Therapy; Disease Transmission, Infectious; DNA, Fungal; Eye Infections, Fungal; Humans; Keratitis; Keratoconus; Keratoplasty, Penetrating; Male; Microbial Sensitivity Tests; Recurrence; Reoperation; Tissue Donors