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Interface Drainage and Antimicrobial Irrigation Avoid Repeat Keratoplasty for Post-DSAEK Cold Interface Abscess.

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A novel surgical technique for post-Descemet stripping automated endothelial keratoplasty (DSAEK) fungal interface keratitis involves anterior keratotomy for diagnosis and targeted antimicrobial delivery, preserving vision and the graft.

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Area of Science:

  • Ophthalmology
  • Microbiology
  • Surgical Techniques

Background:

  • Post-keratoplasty infections pose a significant threat to visual outcomes.
  • Delayed-onset interface infections after Descemet stripping automated endothelial keratoplasty (DSAEK) can be challenging to manage.
  • Fungal keratitis, particularly Candida infections, can present as a sterile-appearing infiltrate or a "cold abscess" at the graft-host interface.

Observation:

  • This study describes a surgical technique for diagnosing and treating post-DSAEK infectious interface keratitis presenting as a cold abscess.
  • The technique involves anterior keratotomy for sample collection and direct antimicrobial delivery to the graft-host interface.
  • Two cases of delayed-onset fungal interface infections (Candida) post-DSAEK were successfully managed with this approach.

Findings:

  • Microbiological examination confirmed Candida species in both cases.
  • Direct antimicrobial therapy via anterior keratotomy led to resolution of infection without recurrence.
  • Both patients achieved excellent visual acuity (20/25 and 20/32) with clear corneas and preserved DSAEK grafts after over 15 months of follow-up.

Implications:

  • Interface drainage with antimicrobial irrigation is a viable management strategy for post-DSAEK interface infections.
  • This anterior surgical approach can prevent intraocular seeding of pathogens, maintain visual function, and avoid repeat keratoplasty.
  • The described technique offers a graft-sparing alternative for managing localized graft-host interface infections after DSAEK.