The purpose of this study was to describe the clinical characteristics of fungal
keratitis caused by Candida albicans in an eye after Descemet stripping automated endothelial
keratoplasty (DSAEK). A 72-year-old male with a history of three
trabeculectomies,
cataract surgery, and two DSAEK procedures developed a
corneal ulcer in his right eye two years after his last DSAEK. Fungal
keratitis was most likely related to the immunosuppressive conditions that occurred due to the previous operations, the continuous use of
steroid eye drops, and the use of disposable
soft contact lenses. A smear and culture from the
ulcer detected Candida albicans.
Slit-lamp examination showed the characteristic feature was the presence of interface infiltrates located between the host and the graft cornea and in the enlarged area around the
ulcer. Two weeks after intense antimycotic treatments with
voriconazole,
miconazole, and
natamycin, perforation of the cornea occurred and further therapeutic
penetrating keratoplasty was required. Histological analysis revealed an accumulation of infiltrated cells and fibrotic tissue. The poor prognosis for fungal
keratitis that occurs in eyes after undergoing DSAEK may be related to the rapid expansion of inflammatory cells through the interface between the host and the graft. In eyes that develop fungal
keratitis after DSAEK, special attention should be paid to the possibility that perforation could occur in these patients.