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

Area of Science:

• Ophthalmology
• Medical Microbiology

Background:

• Corneal endothelial plaques (EPs) can be challenging to diagnose and treat.
• Fungal keratitis is a serious infection requiring prompt and accurate diagnosis.
• Therapeutic penetrating keratoplasty (TPK) is often considered for severe cases.

Purpose of the Study:

• To evaluate the efficacy of the reverse endothelial scraping technique (REST) for diagnosing infection-related corneal endothelial plaques (EPs).
• To assess the utility of REST in guiding targeted antifungal therapy.
• To determine if REST can help avoid invasive procedures like TPK.

Main Methods:

• A patient with a suspected fungal keratitis and corneal EP underwent endothelial scraping using a reverse Sinskey hook.
• Microbiological analysis of the scraped sample identified fungal hyphae.
• Targeted treatment with intracameral and intrastromal voriconazole was administered.

Main Results:

• The reverse endothelial scraping technique (REST) successfully obtained microbiological samples from the corneal EP.
• Microscopy revealed septate branching fungal hyphae, confirming fungal keratitis.
• The patient healed with scarring after targeted voriconazole therapy, achieving a visual acuity of 20/30.

Conclusions:

• The reverse endothelial scraping technique (REST) is effective for microbiological diagnosis of corneal EPs.
• REST facilitates targeted medical treatment, potentially averting the need for penetrating keratoplasty (TPK).
• This minimally invasive approach offers a viable alternative for managing complex corneal infections in young patients.