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Updated: Jun 2, 2026
Corneal Donor Tissue Preparation for Endothelial Keratoplasty
Published on: June 12, 2012
Interface fungal keratitis after endothelial keratoplasty: a clinicopathological report
W Barry Lee1, J Brian Foster, Alan M Kozarsky
1Cornea Section, Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia, USA. lee0003@aol.com
Abstract:
The authors report two cases of interface fungal keratitis following Descemet's stripping automated endothelial keratoplasty (DSAEK). Two patients developed culture-proven interface keratitis with Candida albicans and Candida glabrata following DSAEK. Both patients presented with white interface opacities at approximately 1 month after uncomplicated DSAEK. Adjunct confocal microscopy identified fungal elements prior to surgical therapy. A penetrating keratoplasty was performed in both cases after failed medical therapy with fungal elements confirmed by corneal histopathology. Interface fungal keratitis must be recognized as a potential complication of endothelial keratoplasty. Surgeons should consider corneal donor rim cultures on all endothelial keratopathy cases and confocal microscopy on cases with new interface opacities in the early postoperative period. These measures may lead to early identification and treatment of fungal interface infections.
Insights
Interface fungal keratitis is a rare complication following Descemet
Area of Science:
- Ophthalmology
- Microbiology
Background:
- Descemet's stripping automated endothelial keratoplasty (DSAEK) is an advanced surgical procedure for endothelial dysfunction.
- Interface fungal keratitis is a serious, though uncommon, post-keratoplasty complication.
Observation:
- Two patients developed culture-proven interface fungal keratitis (Candida albicans and Candida glabrata) approximately one month after DSAEK.
- Both patients presented with characteristic white opacities at the graft-host interface.
Findings:
- Confocal microscopy was instrumental in identifying fungal elements preoperatively.
- Medical therapy failed, necessitating penetrating keratoplasty, which confirmed fungal elements via histopathology.
Implications:
- Early recognition of interface fungal keratitis is crucial for successful management after DSAEK.
- Corneal donor rim cultures and confocal microscopy should be considered for suspected cases to facilitate prompt diagnosis and treatment.
