Intrastromal antifungal injection with secondary lamellar interface infusion for late-onset infectious keratitis after DSAEK.

Abstract

The aim of this study was to report the successful medical management of 2 cases of late-onset endothelial keratoplasty-related stromal interface infections. All cases of endothelial keratoplasty-related infections treated with intrastromal antifungal injections were compiled. The following information was collected: demographic data, surgical indications, donor rim cultures, donor mate outcomes, clinical course, diagnostic tests, and clinical outcome. Two cases of interface fungal keratitis diagnosed on clinical appearance and confocal microscopy were identified. Both patients refused to undergo further surgery and failed systemic and/or topical therapy. Each received 3 to 4 intrastromal injections, with secondary infusion into the graft-host interface, which resulted in the complete involution of their interface opacities. Intrastromal antifungal injection may be an effective alternative to surgical intervention in late-onset fungal Descemet stripping endothelial keratoplasty interface keratitis. Early treatment may preserve graft viability and result in a good visual outcome without the need for either penetrating keratoplasty or potential pathogen exposure to the anterior chamber.