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Fungal Interface Keratitis After Descemet Membrane Endothelial Keratoplasty

Victor A Augustin1, Julia M Weller, Friedrich E Kruse

  • 1Department of Ophthalmology, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany.

Cornea
|August 30, 2018
PubMed
Abstract

Insights

Fungal interface keratitis (IK) is a rare complication after Descemet membrane endothelial keratoplasty (DMEK), occurring in 0.15% of cases. Early aggressive fungal IK requires graft exchange, while late infections may be treated without it.

Area of Science:

  • Ophthalmology
  • Microbiology

Background:

  • Descemet membrane endothelial keratoplasty (DMEK) is an advanced endothelial keratoplasty technique.
  • Fungal interface keratitis (IK) is a potential, though rare, complication following DMEK.

Purpose of the Study:

  • To determine the incidence, clinical presentation, and management strategies for fungal IK post-DMEK.

Main Methods:

  • A retrospective case series analyzed 3950 DMEK procedures.
  • Six cases of fungal IK were identified and evaluated for graft storage, causative fungal species, treatment protocols, and visual outcomes.

Main Results:

  • The incidence of fungal IK was 0.15% (6/3950 eyes).
  • Candida species were the predominant pathogens. Early-onset fungal IK (3-5 days) often required graft removal, while late-onset infections (16-42 days) were managed without graft exchange.
  • Recurrence was noted in some cases, and final visual acuity varied significantly.

Conclusions:

  • Fungal IK is a rare but serious complication of DMEK.
  • Aggressive early fungal IK necessitates prompt graft exchange combined with comprehensive antifungal therapy.
  • Late fungal IK may be successfully treated without graft exchange, guided by clinical presentation.

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