Abstract
This is a case of young patient presented with granulomatous anterior and posterior uveitis, which turned to be fungal endophthalmitis after penetrating keratoplasty. Her symptoms were undetected because she was on systemic and topical steroids.
 Key words: Candida, Endophthalmiltis, Penetrating Keratoplasty, negative donner rim.
 The patient is 25 years old Caucasian female patient, previously medically free, who visited our department in the city of Amman, Jordan, for left penetrating keratoplasty for severe keratoconus. After an initial improvement in her vision and a smooth postoperative course, she presented with drop of vision, photophobia, and non-specific eye pain, on examination was found to have anterior granulomatous uveitis. She was started on systemic steroids and the topical steroids were increased in intensity. The initial systemic workup for granulomatous anterior uveitis was negative. However, culture from the aqueous was positive for Candida Galibrata, but the donor rim was negative. Later on the patient developed vitritis despite being on systemic fluconazole and topical Amphotericin B. She was treated with intravitreal Amphotericin B.
 The vitritis improved, but vitreous opacities developed which deteriorated her vision. A parsplana vitetrectony was done.
 Her final visual acuity remained poor because of opacified graft. 
 The patient’s unfortunate case represents a Candida endophthalmitis after penetrating keratoplasty despite being medically free.
Highlights
Corneal transplantation is considered a proved way of treatment of various corneal disorders [1]
The symptoms of Candida endophthalmitis may include loss of vision which may be unrecognized in cases of endogenous endophthalmitis, visual acuity may not be affected if the lesion is peripheral, red eye, and photophobia, pain, floaters or scotoma may be present
Candida endophthalmitis typically presents as several small well demarcated peripheral creamy lesions surrounded by vitreous inflammation, Roth spots, which are areas of chorioretinitis surrounded by hemorrhages, may be present
Summary
Corneal transplantation is considered a proved way of treatment of various corneal disorders [1]. Is a rare but well known complication that occurs post transplantation [2]. It had an incidence of 1.4 per 10000 transplants. Fungal infections of post keratoplasty can lead to severe complications [1]. Candida chorioretinitis typically presents as several, small, creamy white, circumscribed chorioretinal lesions with overlying vitreous inflammation. In certain cases, these chorioretinal lesions may be surrounded by hemorrhage, giving them the appearance of a white-centered hemorrhage. In case the infection is not detected the disease advances, epiretinal membranes may develop, leading to vitreoretinal traction and retinal detachment. Iridocyclitis often is present, and fungal infection of the iris and ciliary body is rare [3]
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