Infectious crystalline keratopathy

A 57-year-old white female was noted to have unusual intrastromal crystalline-like opacities in her failing right corneal graft five months after transplant surgery. Cultures grew Streptococcus viridans; since the graft was failing it was replaced and sent for pathologic examination. H&E stains revealed intrastromal pockets of basophilic material between the lamellae; there was a notable absence of inflammatory cells. Gram's stain showed the basophilic material to be gram positive and transmission electron microscopy confirmed the presence of intrastromal pockets of bacteria. The term "infectious crystalline keratopathy" was coined by Meisler for this entity, which occurs following longterm topical steroid usage. The quite clinical appearance may make its infectious etiology unapparent. Management consists of discontinuation of the steroids and the administration of antibiotics; continued infection, corneal scars, or graft failure may occur and transplantation is then required.