Reverse endothelial scraping technique (REST) for an infectious corneal endothelial plaque

A male patient in his 20s, suffering from a persistent, infection-related corneal endothelial plaque (EP) was urgently referred to our tertiary medical centre for therapeutic penetrating keratoplasty (TPK). Over the preceding month, he had been undergoing treatment with both topical and oral antifungal medications due to clinical suspicion of fungal keratitis. At our centre, an endothelial scraping was performed using a reverse Sinskey hook to obtain samples for microbiology and revealed septate branching fungal hyphae. After targeted therapy with intracameral and intrastromal voriconazole injections, the EP healed with scarring and a final visual acuity of 20/30 was achieved. This highlights efficacy of the reverse endothelial scraping technique (REST) in obtaining microbiological samples from corneal EPs, facilitating targeted medical treatment and averting the need for invasive procedures like penetrating keratoplasty in young patients.