Salvaging The Cornea: Successful Management Of Candida Guilliermondii Keratitis After Intrastromal Ring Implantation With Deep Anterior Lamellar Keratoplasty

To report a case of infectious keratitis caused by Candida guilliermondii after intrastromal corneal ring segment (ICRS) implantation, successfully managed with deep anterior lamellar keratoplasty (DALK). The case highlights the importance of early diagnosis and treatment to prevent intraocular extension and the need for penetrating keratoplasty (PKP). A review of the literature on DALK for infectious keratitis will also be presented.

This study was conducted at Oftalmo Center Ecuador Eye Clinic in Quito, Ecuador.

A 26-year-old female presented with conjunctival hyperemia and a progressive stromal leukoma at the site of a previously implanted intrastromal corneal ring in her left eye. The ICRS had been inserted at another institution in January 2024 and was later removed in July 2024 due to worsening corneal opacity. However, the leukoma continued to enlarge, raising suspicion of infectious keratitis.

Given the clinical presentation, a deep anterior lamellar keratoplasty (DALK) was performed in November 2024 in our institution. Corneal tissue samples were sent for histopathological examination and culture, confirming an infection caused by Candida guilliermondii. Postoperatively, the patient was managed with antifungal therapy and monitored closely for recurrence.

At the 4-month follow-up, there was no evidence of recurrent infection, and the patient achieved an uncorrected visual acuity of 20/40.

Fungal infections following ICRS implantation can present as progressive stromal leukomas, and early recognition is crucial to avoid intraocular invasion and the need for penetrating keratoplasty. DALK is a viable surgical approach for managing infectious keratitis while preserving corneal integrity. This case emphasizes the importance of prompt surgical intervention and targeted antifungal therapy to achieve favorable visual and clinical outcomes. A literature review on DALK for infectious keratitis will be discussed.