Crystalline Keratitis After Xen Surgery

The purpose of this case is to present an atypical corneal complication of glaucoma surgery

Infectious crystalline keratitis (ICK) was first reported by Gorovoy in 1983 after a penetrating keratoplasty.

Since then, in ICK has been described as a complication after many ophthalmic procedures, including glaucoma surgery. Concurrent use of corticosteroid is a common factor

A 86 years old female presents  punctate keratopathy and initiates a small corneal neurotrophic ulcer. She has been use 1 drop of topical dexamethasone every 3 hours for 3 weeks, because of recent glaucoma surgery with XEN implant.

Treatment with corticosteroids was reduced and a regimen of artificial tears and tobramycin was added.

One week later, the patients refers to be better, but examination shows the same epithelial defect with a new feathery crystal-like infiltrate in anterior stroma extending for 1.5 mm. The cornea was otherwise clear. There was not conjunctival injection and the glaucoma bleb worked correctly with intraocular pressure of 8 mmHg.

Corneal culture was performed and treatment was started with reinforced antibiotics and topical voriconazole. Directly, the patient reported suffering from recurrent oral and genital infections due to Candida.

Culture were negative and after an initial deterioration, 2 weeks later the infiltrate was decreasing. At 4 weeks the infiltrate was completely resolved with a small inactive leucoma

Diagnosis of the infective pathogens may be difficult, with a corneal scraping often being too superficial to obtain an adequate specimen. Nevertheless, early recognition of the condition is essential for a good outcome.

To our knowledge, this is the first reported case of ICK after glaucoma surgery with XEN implant.