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Updated: May 4, 2026
Corneal Donor Tissue Preparation for Descemet's Membrane Endothelial Keratoplasty
Published on: September 17, 2014
Methicillin-Resistant Staphylococcus aureus Keratitis after Descemet's Stripping Automated Endothelial Keratoplasty
Tatsuro Miyamoto1, Hiroshi Eguchi1, Ehkhmaa Tserennadmid1
1Department of Ophthalmology, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan.
Purpose:
We report a case of methicillin-resistant Staphylococcus aureus (MRSA) keratitis after Descemet's stripping automated endothelial keratoplasty (DSAEK).
Case Report:
An 87-year-old woman who had undergone a DSAEK 4 months previously was referred to Tokushima University Hospital with a diagnosis of infectious keratitis after DSAEK. A white abscess and infiltration in the inferior cornea of the right eye were observed. We started an empiric therapy using topical levofloxacin and chloramphenicol on the basis of the microscopic findings of the corneal scraping concurrently with cultivation of the cornea.
Results:
A strain of MRSA was isolated from the corneal sample. Although the strain was susceptible to chloramphenicol, it was resistant to quinolone. The keratitis improved rapidly due to empiric therapy, and topical steroids could be resumed 6 days after initiation of the empiric therapy.
Conclusions:
To our knowledge, this is the first case of MRSA keratitis, and the second case of bacterial keratitis, after DSAEK. MRSA keratitis can occur following uneventful DSAEK. The empiric therapy on the basis of results from a light microscopic examination of a Gram-stained corneal scraping and restarting topical steroids in the early stages of medication contributed to the good clinical course of this case.
Insights
Methicillin-resistant Staphylococcus aureus (MRSA) keratitis is a rare complication following Descemet
Area of Science:
- Ophthalmology
- Microbiology
- Infectious Diseases
Background:
- Descemet's stripping automated endothelial keratoplasty (DSAEK) is a common procedure for treating corneal endothelial dysfunction.
- Post-keratoplasty infections, though infrequent, can lead to significant visual impairment.
- Methicillin-resistant Staphylococcus aureus (MRSA) is a notable pathogen in healthcare-associated infections.
Observation:
- A case of infectious keratitis was diagnosed in an 87-year-old woman 4 months after DSAEK.
- Clinical examination revealed a white abscess and infiltration in the inferior cornea of the right eye.
- Corneal scraping and cultivation were performed for microbiological analysis.
Findings:
- The corneal culture isolated a strain of MRSA.
- The isolated MRSA strain was susceptible to chloramphenicol but resistant to quinolones.
- Empiric therapy with topical levofloxacin and chloramphenicol led to rapid improvement of keratitis.
Implications:
- This is the first reported case of MRSA keratitis following DSAEK, highlighting a potential risk.
- Prompt empiric therapy guided by Gram stain microscopy and early resumption of topical steroids can lead to favorable outcomes.
- Ophthalmologists should consider MRSA in the differential diagnosis of keratitis after DSAEK, even in uneventful cases.
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