Related Experiment Videos
Candidal endophthalmitis after keratoplasty
A Merchant1, C M Zacks, K Wilhelmus
1The Aga Khan University Hospital, Karachi, Pakistan.
Purpose:
To report a case of explosive fungal endophthalmitis after penetrating keratoplasty and to review additional published and unpublished cases to consider possible strategies for prevention.
Methods:
Records of this patient with postkeratoplasty candidal endophthalmitis and previously reported cases of postkeratoplasty candidal endophthalmitis were reviewed. Additional information of 26 unpublished cases was obtained from the Eye Bank Association of America.
Results:
After standard keratoplasty, the patient developed precipitous endophthalmitis on the second postoperative day. Abundant contamination with Candida was found in the residual donor corneoscleral rim, and Candida albicans was isolated from the aqueous humor of the recipient. Despite therapy with local antimicrobial agents, intraocular amphotericin B, and systemic fluconazole, the patient had a poor outcome with hand-motion visual acuity. Of the 44 collected cases of postkeratoplasty candidal endophthalmitis, 40 (91%) had the same organism cultured from the donor rim or medium. Forty-three donor corneas had been preserved in cold storage medium at 4 degrees C. Of 15 cases in which the outcome was available, 9 (60%) resulted in visual acuity of 20/200 or worse.
Conclusion:
Case reports confirm the occurrence of donor-to-host transmission of postkeratoplasty candidal endophthalmitis. Despite the low reported incidence, the poor prognosis of the affected eye in the ajority of these cases suggests the need for antifungal supplementation of cold preservation media and other preventative strategies.
Insights
Donor corneas can transmit fungal infections like Candida endophthalmitis after penetrating keratoplasty. This review highlights the poor outcomes and suggests antifungal supplementation of preservation media to prevent transmission.
Area of Science:
- Ophthalmology
- Mycology
- Infectious Diseases
Background:
- Penetrating keratoplasty is a common procedure for corneal blindness.
- Fungal endophthalmitis is a rare but serious complication following corneal transplantation.
- Donor-to-host transmission of fungal pathogens poses a significant risk.
Observation:
- A case of explosive Candida endophthalmitis occurred two days post-keratoplasty.
- Candida was identified in the donor corneoscleral rim and recipient's aqueous humor.
- Most donor corneas were preserved in standard cold storage media.
Findings:
- Review of 44 cases revealed 91% had Candida cultured from donor rim or medium.
- Sixty percent of cases with available outcomes had visual acuity of 20/200 or worse.
- Poor visual outcomes were common despite aggressive treatment.
Implications:
- Donor-to-host transmission of fungal endophthalmitis is confirmed.
- Antifungal supplementation of corneal preservation media is recommended.
- Preventative strategies are crucial to improve outcomes in post-keratoplasty fungal endophthalmitis.