Case Reports

Post keratoplasty difficulties in cataract removal in patient after fungal-protozoal keratitis

Case Report Details

First Author: M.Kozikowska POLAND

Co Author(s):    W. Lubon   K. Rycman   A. Smedowski   E. Mrukwa-Kominek           

Abstract Details

Purpose:

The aim of the study is to present a complicated surgery and perioperative management in patients who prior underwent Penetrating Keratoplasty due to severe concomitant Fusarium combined with protozoal - Acanthamoeba infection keratitis

Setting:

1 Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Poland 2 Department of Ophthalmology, Professor K. Gibinski University Clinical Center of the Medical University of Silesia, Katowice, Poland 

Report of Case:

In this study a 37 years old patient with previous keratoplasty due to fungal and protozoal keratitis and one episode of graft rejection developed severe secondary intumescent cataract. Penetrating keratoplasty was done after successful antifungal treatment with additional antirejection therapy causing one year stabilisation of the clinical stage. The BCDVA after PK was 0.4 (decimal Snellen scale). Development of cataract was accelerated 9 months after surgery. The cause of this acceleration was due to previous surgical manoeuvres, earlier infection and steroid treatment in large doses in the course of graft rejection. At the time of coming to surgery BCVA preoperative was 0.01, IOP 26 mmHg , keratometry Ks: 44.38 @96o Kf: 40.95 @ 6o . IOL calculation was repeated many times on different machines and using on-line available calculators and decided to implant lens power 18.50D - also closest to measurements from the second, healthy eye. The operation was successful despite difficult conditions and the need to constantly change phaco parameters. BCDVA one week post operatively improved to 0.3; IOP 14mmHg, keratometry Ks 44.25o @ 93 Kf 40.54@3o Cornea was clear – no current haze. Two weeks after surgery initial corneal transplant rejection was noticed, VA diminished to 0.1. Hospitalization and intensive treatment followed very quickly - general and local treatment improvement in clinical stage was achieved and maintaining visual acuity at a level 0.3.

Conclusion/Take Home Message:

Phacoemulsification after penetrating keratoplasty may be challenging surgical procedure, anticipation of complications is indispensable, but may result in good outcome. There are also a high rate of possible intraoperative complications which need to careful postoperative ophthalmology observation and antirejection therapy.

Financial Disclosure:

None