Candida Endophthalmiltis Following Penetrating Keratoplasty in Patient with Negative Donor Rim; A case report with review literature of diagnosis and treatment of fungal endophthalmitis.

Abstract

This is a case of young patient presented with granulomatous anterior and posterior uveitis, which turned to be fungal endophthalmitis after penetrating keratoplasty. Her symptoms were undetected because she was on systemic and topical steroids. Key words: Candida, Endophthalmiltis, Penetrating Keratoplasty, negative donner rim. The patient is 25 years old Caucasian female patient, previously medically free, who visited our department in the city of Amman, Jordan, for left penetrating keratoplasty for severe keratoconus. After an initial improvement in her vision and a smooth postoperative course, she presented with drop of vision, photophobia, and non-specific eye pain, on examination was found to have anterior granulomatous uveitis. She was started on systemic steroids and the topical steroids were increased in intensity. The initial systemic workup for granulomatous anterior uveitis was negative. However, culture from the aqueous was positive for Candida Galibrata, but the donor rim was negative. Later on the patient developed vitritis despite being on systemic fluconazole and topical Amphotericin B. She was treated with intravitreal Amphotericin B. The vitritis improved, but vitreous opacities developed which deteriorated her vision. A parsplana vitetrectony was done. Her final visual acuity remained poor because of opacified graft.    The patient’s unfortunate case represents a Candida endophthalmitis after penetrating keratoplasty despite being medically free.