Donor-to-host transmitted Candida endophthalmitis after penetrating keratoplasty

OBJECTIVE: To report the first case of Candida albicans endophthalmitis following penetrating keratoplasty after warm preservation. DESIGN: Observational case report. METHODS: We reviewed the patient's chart and the available literature on fungal endophthalmitis after keratoplasty. RESULTS: After keratoplasty, a 45-year-old man developed an endophthalmitis on the first postoperative day. The same day, results of the culture of the transportation medium were available and revealed Candida albicans. Despite therapy with topical and subtenon amphotericin B, there was no clinical improvement, and a regraft was performed 4 days after the initial corneal transplant. A best corrected visual acuity of 20/32 was achieved. CONCLUSION: The majority of reported cases of postkeratoplasty candidal endophthalmitis are associated with cold storage preservation and a poor prognosis of the affected eye. We describe a case of postkeratoplasty candidal endophthalmitis after organ-cultured preservation, with a final visual acuity above expectations. In our opinion, early diagnosis based on routine culturing of the transportation medium and early removal of the infected corneal graft when local antifungal therapy failed are important factors contributing to the good clinical outcome.