Aspergillus flavus keratitis after deep anterior lamellar keratoplasty

To report the clinical, microbiologic, confocal scan and histopathologic features of Aspergillus flavus keratitis which developed immediately after deep anterior lamellar keratoplasty (DALK).

A 28-year-old woman underwent DALK using the big-bubble technique for keratoconus. The operation was uneventful, yielding a bare Descemet's membrane (DM) followed by transplantation of a corneal graft devoid of DM and endothelium. Four days after keratoplasty, mild infiltrates were noticed in the inferonasal margin of the graft, which rapidly progressed to involve the adjacent recipient cornea. Confocal scan findings suggested filamentous fungal keratitis, leading to initiation of topical and systemic antifungal medications followed by immediate replacement of the graft. Histopathologic examination disclosed keratitis caused by a filamentous fungus, which was determined by microbiologic cultures to be Aspergillus flavus. Early diagnosis and appropriate management resulted in complete recovery from this potentially devastating infection.

Aspergillus Flavus can cause graft ulcers immediately after DALK. Confocal scan proved to be a valuable tool for early diagnosis and prompt intervention to control this otherwise devastating infection.