BIOFILM FORMATION IN INFECTIOUS CRYSTALLINE KERATOPATHY DUE TO CANDIDA-ALBICANS

Infectious crystalline keratopathy (ICK) is an uncommon, indolent corn eal infection in which the slow clinical course contrasts with the rap id laboratory growth and microbiological sensitivities of the infectin g organism. This prospective study aimed to determine whether biofilm production was the cause of this disparity. A case of failed medical m anagement of ICK in a patient with Stevens-Johnson syndrome is present ed. A penetrating keratoplasty yielded corneal tissue that was freshly fixed for electron microscopy using 0.05% ruthenium red and 2.5% glut eraldehyde. Candida albicans was grown from 3/3 broths, and fungi with morphology consistent with Candida were seen on histological examinat ion. Electron microscopy revealed microorganisms morphologically typic al of Candida surrounded by a polysaccharide-rich glycocalyx consisten t with a biofilm. We concluded that Candida albicans is capable of pro ducing a biofilm and is a known cause of ICK. This case is supportive evidence that biofilm production is associated with cases of ICK and m ay explain the chronic, pauciinflammatory features of ICK and its rela tive resistance to antibiotic treatment.