This case report addresses the challenges in diagnosing and managing fungal keratitis following uneventful descemet membrane endothelial keratoplasty (DMEK) in a 60-year-old female. She developed diffuse keratic precipitates following uneventful DMEK. Initial diagnostic tests were inconclusive, including anterior chamber tap and confocal microscopy. The patient’s condition worsened, necessitating therapeutic keratoplasty. After the therapeutic keratoplasty, the corneal button culture confirmed Candida species. Despite aggressive antifungal therapy, the patient’s visual outcome was poor, with significant graft opacification and vascularization. This case highlights the diagnostic challenges of fungal interface infectious keratitis post-DMEK, emphasizing the need for early empirical antifungal therapy despite inconclusive initial diagnostic tests. Consideration of the previous medical history and immune status is crucial in perioperative management.
Venugopal et al. (Tue,) studied this question.