Infectious crystalline keratopathy

A 76-year-old patient was found to have a crystalline keratopathy with no evidence of acute inflammation in her right corneal graft. The patient had been on long-term topical steroids. Subsequent microscopy of the graft demonstrated pockets of Gram-positive cocci with a paucity of inflammatory cells. This is the tenth reported case of infectious crystalline keratopathy, first reported by Gorovoy in 1983. It does not always occur in corneal grafts, but the use of long-term topical steroids, together with an epithelial defect, allows the microorganism, usually Streptococcus viridans, to invade the corneal stroma and replicate along the lamellar planes, unhindered by the usual inflammatory response. Retrospective analysis of this patient's history suggests that she has suffered the same keratopathy in previous corneal grafts. Treatment involves cessation of steroids, antibiotic cover and often a repeat penetrating keratoplasty. If this is required, the lowest possible dose of steroid cover should be used with prolonged use of topical antibiotics. To the best of our knowledge this is the first reported case of infectious crystalline keratopathy in Australia.