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Sandwich infectious keratitis after endothelial keratoplasty

Poster Details

First Author: P.Cidad Betegón SPAIN

Co Author(s):    A. del Hierro Zarzuelo   A. Boto de los Bueis   E. González Sánchez   F. Sánchez-Carnerero Casas   A. García Tirado  

Abstract Details



Purpose:

Endothelial keratoplasty is the treatment of choice for certain endothelial diseases like bullous keratopathy. That is the reason why corneas from donors of refractive surgery have become part of the pool of donor corneas for this type of surgery. We report the case of a patient who underwent DSAEK by Fuchs Endothelial Dystrophy, from a donor cornea LASIK operated, and in which after donor impeller culture was shown Corynebacterium sp. infection.

Setting:

Servicio de Oftalmología. Hospital Universitario La Paz. Madrid.

Methods:

Male, 86 years old patient, in tracking by Fuchs Endothelial Dystrophy, in which was performed a left eye DSAEK from a donor cornea that had undergone refractive surgery.

Results:

The tenth day after surgery the Microbiology Department reported the growth of Corynebacterium sp. in growing donor. By biomicroscopy the graft was clear, so it was decided to observe the patient closely without starting treatment. Two months after surgery was observed graft temporal refolding and three lower limbal infiltrates at the interface level. Treatment was started with topical ciprofloxacin, tobramycin and dexamethasone. A week later it was observed that the 7 hours infiltrate was denser, so it was prescribed amoxicillin / clavulanic acid orally. Because of patient"s worsening it was underwent drainage of the infiltrates, anterior chamber irrigation and intrastromal injection of penicillin. A month later, the infiltrates were resolved, however, the cornea is decompensated, currently pending penetrating keratoplasty.

Conclusions:

When microbiological diagnosis is not possible in sandwich infectious keratitis, due to inaccessibility to the sampling, we can raise the draining of the abscess or the removal of the lenticule. The deep level location of the infiltrate difficult drug penetration and it is essential to start with intensive treatment regimens from the outset. Some authors advocate the removal of the lenticule in the acute phase, while others promote observation to the resolution of this stage.

Financial Disclosure:

NONE

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