Keyhole Shaped Therapeutic Penetrating Keratoplasty For Post-Dsaek Interface Infection Associated With Peripheral Fungal Abscess

To describe keyhole shaped therapeutic penetrating keratoplasty technique for post-DSAEK interface infectionassociated with a peripheral fungal abscess

Ospedali Privati Forlì, "Villa Igea", Forlì, Italy

Keyhole-shaped therapeutic penetrating keratoplasty was performed as follows: Peripheral fungal abscess was initially debulked by a trapezoidal shaped full-thickness excision at the corneoscleral limbus (base= 3mm and 4mm, height= 2mm). A 6-mm full-thickness trephinationcentered on the limbus was then performed. The DSAEK graft was explanted. The donor cornea was initially punched full-thickness at 9mm diameter and then eccentrically cut using a 6mm incomplete C-shapedmodified punch leaving an uncut peripheral corneal rim which was then fashioned as a trapezoidal shaped corneal flap. The resulting keyhole-shaped graft was fixated onto the host cornea with interrupted nylon 10-0 sutures.

A 69-year-old female referred to our center for evaluation of an interface infection that developed 4 weeks following DSAEK. A dense fluffy stromal abscess involving into the superior corneoscleral limbus was observed. Microbial examination revealed Candida albicans. No response was observed with topical, intrastromal and intracameral injections with amphotericin B and voriconazole. Keyhole-shaped therapeutic penetrating keratoplasty was performed as described. Topical amphotericin B and voriconazole was continued over 4 months until clinical resolution of the infection. Patient developed secondary glaucoma. Six months postoperatively, Snellen BSCVA was 20/200.

In patients with peripheral infections involving the sclerocorneal limbus, keyhole shaped therapeutic penetrating keratoplasty can maximize the area of peripheral debridement and debulking, thereby achievingclinical resolution of severe fungal keratitis.