Fungal endophthalmitis after descemet stripping automated endothelial keratoplasty--a case report

BACKGROUND/AIMS: Descemet stripping automated endothelial keratoplasty (DSAEK) is increasingly gaining popularity as an effective alternative to traditional penetrating keratoplasty for the treatment of endothelial diseases. However, new complications such as donor graft dislocation are seen after DSAEK. Surface venting incisions have been advocated to reduce rates of graft dislocation. We report a case of post-DSAEK fungal endophthalmitis in which the clinical course may have been influenced by the presence of surface venting incisions. METHOD: A retrospective case report. RESULTS: A 72-year-old woman, who developed primary/iatrogenic graft failure after DSAEK, underwent a repeat DSAEK. Corneal venting incisions were reopened at the original sites as her first operation. Early postoperatively, she developed intrastromal opacities, which were thought to be epithelial downgrowth, but progression and increasing stromal and intraocular inflammation required anterior chamber and vitreous tap, which confirmed the presence of Candida parapsilosis, confirming the diagnosis of fungal endophthalmitis. Penetrating keratoplasty, removal of the posterior lamellar graft, removal of the posterior chamber intraocular lens implant (PCIOL) and capsular bag, and anterior vitrectomy were performed after failure of conservative antifungal therapy. Postoperatively, no recurrence of infection occurred, and the graft has remained clear at her most recent follow-up at 6 months, with a best-corrected visual acuity of 20/40. CONCLUSIONS: Corneal venting incisions in DSAEK surgery may be a portal of entry for microorganisms, leading to corneal and intraocular infection, and a high index of suspicion is warranted in the presence of stromal infiltrates or inflammation at venting sites.