Post‐DMEK bacterial interface keratitis treated with intrastromal and intracameral antibiotics

Abstract

Case Report A 61–year old woman presented in our clinic complaining of blurred vision in the right eye (OD). Best‐corrected visual acuity (BCVA) OD was 0.05. Central corneal thickness was 794μm. She had undergone complicated phacoemulsification with sulcus‐placed intraocular lens in the affected eye six months ago, so we set the diagnosis of pseudophakic bullous keratopathy and decided to proceed with Descemet Membrane Endothial Keratoplasty (DMEK). DMEK with 20% SF6 gas was performed uneventfully on the right eye. On first postoperative day, slitlamp examination revealed a paracentral corneal infiltrate in the interface with intact overlying epithelium. We injected 0.1 mL of 0.5% vancomycin and 0.1 mL of 0.8% amikacin, adjacent to the infiltrate into the mid‐stroma. Intracameral injection of 0.1 mL of 0.5% vancomycin was also performed. Topical 5% vancomycin and 2.5% amikacin eyedrops were administered hourly in addition to moxifloxacin eyedrops four times a day and preservative‐free dexamethasone eyedrops two times a day. We observed complete resolution of the infection by the twelfth day after injection.In SummaryIntrastromal and intracameral antibiotic injection is an effective and safe treatment modality for post‐DMEK interface keratitis, which physicians should consider when managing such cases.