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Donor-Related Candida Keratitis After Descemet Stripping Automated Endothelial Keratoplasty

Kitzmann, Anna S MD; Wagoner, Michael D MD; Syed, Nasreen A MD; Goins, Kenneth M MD

doi: 10.1097/ICO.0b013e31819140c4
Case Report

Purpose: To report 2 cases of donor-to-host transmission of Candida albicans interface keratitis after Descemet stripping automated endothelial keratoplasty (DSAEK).

Methods: We performed clinical and microbiologic examinations on 2 patients who underwent DSAEK for pseudophakic corneal edema.

Results: Two patients underwent uneventful DSAEK surgery using corneal tissue from the same donor. The donor corneoscleral rims were cultured at the time of surgery and both rims subsequently grew C. albicans and Candida glabrata. Approximately 5 weeks after surgery, infiltrates were noted in the DSAEK interface in both of these patients. Despite treatment with antifungal therapy, the Candida keratitis was unable to be controlled medically and required surgical intervention in each case, after which there was no recurrence of infection.

Conclusions: Candida interface keratitis can occur after DSAEK. These 2 cases emphasize the importance of donor corneoscleral rim cultures, especially with the increase in lamellar and endothelial keratoplasty, which can make such interface infections more difficult to diagnose and treat. Patients with fungal positive donor corneal rim cultures should be prophylactically treated with antifungal therapy.

From the Departments of *Ophthalmology and Visual Sciences and †Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA.

Received for publication June 25, 2008; revision received October 8, 2008; accepted October 12, 2008.

Reprints: Kenneth M. Goins, MD, Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242 (e-mail:

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