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Adjuvant Stromal Amphotericin B Injection for Late-Onset DMEK Infection
1*University of Illinois Eye and Ear Infirmary, Chicago, IL; and †Department of Ophthalmology, Rush University Medical Center, Chicago Cornea Consultants, Chicago, IL.
Purpose:
To report the successful medical management of a late-onset Descemet membrane endothelial keratoplasty (DMEK)-related interface infection.
Methods:
A case of DMEK endothelial keratoplasty-related infection treated with intrastromal antifungal injection was identified. The following information was collected: demographic data, surgical indications, donor rim cultures, donor mate outcomes, clinical course, diagnostic tests, and clinical outcome.
Results:
A DMEK patient developed a single infiltrate approximately 1 month after uncomplicated DMEK. Donor rim culture was positive for Candida glabrata but no prophylactic treatment was initiated. Anterior segment optical coherence tomography confirmed the location of the infiltrate, and the patient was treated with oral fluconazole and an intrastromal injection of amphotericin B with an inadvertent, but negligible, intracameral volume of the same drug. The lesion significantly regressed on examination 2 days later with complete involution and excellent visual acuity to date.
Conclusions:
Medical therapy, including systemic and intrastromal application, is a viable initial treatment option for late-onset, presumed yeast interface keratitis in patients who have undergone DMEK.
Insights
Successful medical management of late-onset Descemet membrane endothelial keratoplasty (DMEK) interface infection was achieved using antifungal therapy. This approach, including intrastromal injection, offers a viable initial treatment for post-DMEK yeast keratitis.
Area of Science:
- Ophthalmology
- Microbiology
Background:
- Descemet membrane endothelial keratoplasty (DMEK) is a common endothelial keratoplasty procedure.
- Late-onset interface infections after DMEK can compromise visual outcomes.
Observation:
- A patient developed a fungal infiltrate (Candida glabrata) in the interface 1 month after an uncomplicated DMEK.
- The infiltrate was localized and confirmed via anterior segment optical coherence tomography.
Findings:
- Treatment with oral fluconazole and intrastromal amphotericin B resulted in significant regression of the fungal lesion.
- The patient experienced complete resolution and excellent visual acuity post-treatment.
Implications:
- Medical management, combining systemic and intrastromal antifungals, is an effective initial strategy for late-onset DMEK-related yeast keratitis.
- This case highlights a successful non-surgical approach to a potentially sight-threatening complication.
