An unusual case of crystalline keratopathy

A 48-year-old woman developed a crystalline stromal lesion four years after a penetrating corneal graft, with few signs of ocular inflammation. An initial diagnosis of fungal keratitis was made because of the appearance of the lesion. An excisional biopsy revealed the presence of Gram-positive cocci lying between the stromal lamellae in the posterior third of the cornea. Large numbers of Gram-positive cocci were observed on light and transmission electron microscopy but no organism could be cultured from the biopsy. The replacement graft has remained clear over the subsequent two years.