Interface infectious keratitis following deep anterior lamellar keratoplasty

A 32-year-old female patient underwent deep anterior lamellar keratoplasty (DALK) in both eyes for advanced keratoconus. She developed an infiltrate in the nasal paracentral interface of the left eye. In view of the paracentral location, localized epithelial removal/stromal scraping was done and the infiltrate was removed using forceps and sent for microbiological assay, which revealed fungal filaments. The patient successfully responded to intensive topical antifungal therapy with the maintenance of visual acuity. Interface keratitis following DALK frequently needs graft lift/interface wash due to deep location, rapid spread and poor penetration and efficacy of topical medications. In view of a paracentral location, modified debulking with topical therapy resulted in a satisfactory outcome in our case thereby avoiding the need for more invasive treatments.