to report a case of candida albicans endophthalmitis after penetrating keratoplasty (PK) for keratoconus

interventional case report

a 21 years old woman known case of advanced keratoconus and vernal keratoconjunctivitis developed with recalcitrant anterior uveitis which was exacerbated with tapering the steroid. Gradually a whitish lesion became apparent on the superonasal of lens underneath the iris which was considered as possible localized traumatic cataract after PK. So with possible impression of Urett Zavalia syndrome versus phacoantigenic uveitis she was on topical steroid till 50th day post operation that made mutton fat keratic percipitates and fibrinous reaction thus she was admitted in the ward and deep vitrectomy, lensectomy , localized iridectomy and irrigation with diluted imipenem and amphothricin was done for her due to clinical suspicion to post operation fungal endophthalmitis. Microbiologic study of vitreous sample revealed growth of candida albicans however optisole culture was negative and donor rim was not evaluated. 1 week later intravitreal amphotricine was injected for her. The patient remained aphakic with clear graft in the 6th month follow up.

Due to great correlation of positive donor rim culture with fungal endophthalmitis and the devastating effect of delayed diagnosis it is wise to have donor rim culture routinely to aid us in earlier diagnosis in the presence of nonspecific early signs of fungal endophthalmitis which occurs insidiously and can be misleading.