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Bacillus cereus Infection After Descemet Stripping Endothelial Keratoplasty

Basak, Samar K. MD, DNB, FRCS; Deolekar, Sheetal S. MS, DNB; Mohanta, Ayan MS; Banerjee, Sanjib DOMS; Saha, Suman MSc

doi: 10.1097/ICO.0b013e31823f0b49
Case Report

Purpose To report the first case of Bacillus cereus keratitis leading to panophthalmitis in a patient operated for combined Descemet stripping endothelial keratoplasty (DSEK) and phacoemulsification with intraocular lens implantation.

Methods A 40-year-old woman with corneal decompensation underwent DSEK with phacoemulsification and posterior chamber intraocular lens implantation and developed corneal infiltrate in the host cornea progressing to ring corneal abscess and panophthalmitis within 72 hours of surgery.

Results The microbiological examination of the patient's corneal scraping revealed Gram-positive rods on the smear and the culture grew B. cereus. The source of the organism was found to be in the conjunctival sac of the patient because the conjunctival swab culture from the other eye revealed B. cereus. Despite vigorous topical and systemic antibacterial therapy, and immediate therapeutic penetrating keratoplasty, the infection progressed to panophthalmitis and required evisceration on the fifth day.

Conclusions Bacillus cereus is a rare potential cause of postoperative infective keratitis after DSEK. The fulminant nature of the infection and its spread resulting in the loss of vision poses diagnostic and therapeutic challenges to corneal surgeons.

*Cornea Department, Disha Eye Hospitals and Research Centre, Barrackpore, Kolkata, India

Microbiology Department, Priyamvada Birla Aravind Eye Hospital, Kolkata, India.

The authors have no financial or conflicts of interest to disclose.

Reprints: Samar K. Basak, Disha Eye Hospitals and Research Centre, Barrackpore, 24 Parganas North, Kolkata 700120, India (e-mail:

Received May 21, 2011

Accepted October 14, 2011

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.