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Treatment approach to a Candida albicans anterior chamber infection after penetrating keratoplasty with excellent outcome

Poster Details

First Author: S.Stunf SLOVENIA

Co Author(s):    A. Herceg   M. Globoc┬Źnik Petrovic   V. Pfeifer              

Abstract Details

Purpose:

To report a rare case of anterior chamber infection after penetrating keratoplasty caused by Candida albicans transfer, the treatment and outcome.

Setting:

Eye Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia

Methods:

Case report: A 53-years old female patient had uneventful keratoplasty in her right eye (RE) due to post infective corneal scar. The donor rime turned out positive for Candida albicans one week after the surgery. The patient was started on preventive topical 1% voriconazole, but despite this, presented with anterior chamber infection with white mass in the anterior chamber 1 month later. Biopsy confirmed Candida albicans transfer from the donor. The antifungal therapy was intensified with intravenous fluconzole, and regular intracameral amfotericin B injections combined with irrigations of the anterior chamber.

Results:

After two weeks of relatively unsuccessful treatment, the infection suddenly calm down. The therapy was tapered and the final outcome of visual acuity of 6/30, graft clarity with CD of 2260 cells per mm2 was considered as an excellent outcome.

Conclusions:

Candida albicans endophthalmitis after keratoplasty represents a good proportion (30%) of all causative agents. Although otherwise debatable microbiological donor rim tests are mandatory to prove the transfer of infection and to focus the antifungal therapy properly. The antifungal therapy should be intensive, following the antibiogram. Due to low penetration of antifungals trough intact corneal epithelium, the intracameral application is of a major importance. The effect of amfotericin B developed after two weeks. Thus repeatable injections into the anterior chamber are necessary to maintain therapeutic concentration for long enough. The reported case represents a good outcome of such approach.

Financial Disclosure:

NONE

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