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Interface keratitis following endothelial keratoplasty.

Ellen H Koo1

  • 1Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.

Saudi Journal of Ophthalmology : Official Journal of the Saudi Ophthalmological Society
|June 30, 2026
PubMed
Summary

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Infectious interface keratitis (IIK) after endothelial keratoplasty (EK) is a serious complication. Early intervention and source control are key, with graft-sparing options for localized infections and therapeutic penetrating keratoplasty for severe cases.

Area of Science:

  • Ophthalmology
  • Infectious Diseases
  • Corneal Surgery

Background:

  • Infectious interface keratitis (IIK) is a rare but severe complication following endothelial keratoplasty (EK).
  • The interface space in EK procedures poses challenges for diagnosis and antimicrobial penetration.
  • Candida species are the most common pathogens identified in IIK post-EK.

Purpose of the Study:

  • To review the epidemiology, microbiology, clinical presentation, management, and outcomes of IIK after EK.
  • To emphasize surgical decision-making in managing IIK following EK.
  • To highlight strategies for graft preservation versus graft replacement.

Main Methods:

  • Systematic review of existing literature and case series on IIK after EK.
  • Analysis of reported causative organisms, clinical findings, and treatment modalities.
Keywords:
Candidacorneal transplantationdescemet membrane endothelial keratoplastydescemet stripping automated endothelial keratoplastydescemet stripping endothelial keratoplastyendothelial keratoplastyinfectious interface keratitisinfectious keratitismicrobial keratitistherapeutic penetrating keratoplasty

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  • Evaluation of outcomes based on different management strategies.

    • Main Results:

    • Candida is the predominant organism causing IIK after EK.
    • Localized infections may be amenable to graft-sparing techniques like interface drainage or intrastromal antimicrobials.
    • Fungal and atypical infections, or progressive cases, often necessitate repeat keratoplasty or therapeutic penetrating keratoplasty (TPK).

    Conclusions:

    • IIK after EK is a deep-seated infection requiring prompt "source control".
    • Early intervention and targeted therapy can potentially preserve the EK graft in select cases.
    • TPK remains the definitive treatment for refractory or progressive IIK post-EK.