PSEUDOPHAKIC CANDIDA-PARAPSILOSIS ENDOPHTHALMITIS WITH A CONSECUTIVE KERATITIS

We describe a case of Candida parapsilosis endophthalmitis with a cons ecutive keratitis after phacoemulsification and posterior chamber intr aocular lens implantation in an otherwise healthy eye. Despite aggress ive medical and surgical management during a 2-year period, multiple e pisodes recurred, with the development of an intracapsular plaque and an infectious nidus on the corneal endothelium 6 months after the init ial presentation. After subtotal removal of the culture-positive capsu le, intravitreal and topical amphotericin B, and oral fluconazole, the inflammation improved. However, the corneal endothelial plaque persis ted with recurrent inflammation 2 months later, prompting debridement of the culture-positive plaque and further removal of the culture-nega tive capsular remnants and lens implant. The infection was quiescent f or the subsequent 12-month period until recurrent intraocular inflamma tion developed with enlargement of the endothelial plaque. Culture of this plaque was again positive for C. parapsilosis. After debridement and intraocular and topical amphotericin B, the eye has now been quies cent for 13 months. This case demonstrates the development of a second ary keratitis in an eye affected by pseudophakic C. parapsilosis endop hthalmitis, with the posterior cornea serving as a sanctuary site for the fungus despite aggressive management leading to recurrent infectio n 1 year after the clinical disease appeared to be quiescent.