Therapeutic Keratoplasty : A Case Report

The aim of this study is to assess the anatomical and functional prognosis of therapeutic keratoplasty in the treatment of a fungal keratitis.

Therapeutic keratoplasty is of great interest in the treatment of advanced cases of large or pre-perforate infectious keratitis. Fungal keratitis requires complex management due to the lack of codified treatment and the unpredictable therapeutic response. The postoperative period is also risky because of the potential risk of recurrence and acute rejection.

This is a 10-year-old patient, followed for keratoconus, who underwent intracorneal ring  segment implantation in the left eye. The patient was addressed for keratitis, resistant to conventional medical treatment. Ocular ultrasound examination showed the presence of vitritis.

The patient underwent a penetrating keratoplasty procedure for therapeutic purposes. The postsurgical onset was characterized by severe inflammation. The microbiological analysis found the presence of strains of Candida Parapsilosis.

The literature describes therapeutic keratoplasty as a management option of infectious keratitis resistant to maximal medical treatment, or with an eminent risk of corneal perforation, or endophthalmitis.

The post-operative period is the most complex to manage as it requires close monitoring with day-to-day adaptation of the treatment.

Whatever the etiology, the main objective of therapeutic keratoplasty is to preserve the integrity of the eye and to eradicate the infectious process, visual rehabilitation is a secondary objective.

Anterior lamellar grafts can be an alternative that could improve the postoperative period of these patients, however the indication for the graft must be made early.