Candidal endophthalmitis after keratoplasty

Purpose. To report a case of explosive fungal endophthalmitis after penetra ting keratoplasty and to review additional published and unpublished cases to consider possible strategies for prevention. Methods. Records of this pa tient with postkeratoplasty candidal endophthalmitis and previously reporte d cases of postkeratoplasty candidal endophthalmitis were reviewed. Additio nal information of 26 unpublished cases was obtained from the Eye Bank Asso ciation of America. Results. After standard keratoplasty, the patient devel oped precipitous endophthalmitis on the second postoperative day. Abundant contamination with Candida was found in the residual donor corneoscleral ri m. and Candida albicans was isolated from the aqueous humor of the recipien t. Despite therapy with local antimicrobial agents, intraocular amphoterici n B, and systemic fluconazole. the patient had a poor outcome with hand-mot ion visual acuity. Of the 44 collected cases of postkeratoplasty candidal e ndophthalmitis. 40 (91%) had the same organism cultured from the donor rim or medium. Forty-three donor corneas had been preserved in cold storage med ium at 4 degreesC. Of 15 cases in which the outcome was available. 9 (60%) resulted in visual acuity of 20/200 or worse. Conclusion. Case reports conf irm the occurrence of donor-to-host transmission of postkeratoplasty candid al endophthalmitis. Despite the low reported incidence, the poor prognosis of the affected eye in the majority of these cases suggests the need for an tifungal supplementation of cold preservation media and other preventative strategies.