Atypical mycobacterial interface infection after Descemet's membrane endothelial keratoplasty

Session Details

Session Title: Infections

Session Date/Time: Sunday 23/09/2018 | 16:30-18:00

Paper Time: 17:30

Venue: Room A3, Podium 3

First Author: : R. Van Landeghem BELGIUM

Co Author(s): :    B. Foets   S. Desmet   M. Vanhaecke   M. Hua           

Abstract Details

Purpose:

Corneal transplantation procedures are increasingly performed, with a current dominance of newer lamellar corneal transplantation techniques over penetrating keratoplasty. These lamellar techniques also changed the spectrum of post-operative infectious keratitis, as there is a risk of corneal infection at the interface of graft and host tissue. Interface infections require early and intensive medical treatment, which can be difficult due to late presentation and diagnostic delay. Surgical intervention is often necessary to reach resolution.

Setting:

University Hospitals Leuven, Dept. of Ophthalmology.

Methods:

Retrospective case report

Results:

A 76-year-old man developed infectious interface keratitis after descemet membrane endothelial keratoplasty (DMEK) for Fuchs dystrophy. Cultures of the donor cornea transport medium isolated Mycobacterium chelonae. Subsequent clinical investigation showed early signs of infectious keratitis with multiple infiltrates at the donor-graft interface. Cultures at the cornea bank of origin also showed M. chelonae, indicating a donor related infection. Due to unsuccessful medical therapy, exchange of the DMEK graft was necessary, four and a half months after initial DMEK. After two weeks some interface precipitates appeared and remained stable over the following months. Antibiotic therapy was successfully ended after five months.

Conclusions:

Although atypical mycobacteria are a rare cause of interface infection, multiple cases have been published. In all of these cases older techniques of lamellar keratoplasty were used. To the best of our knowledge, this is the first case of donor-related atypical mycobacterial interface keratitis after DMEK. This case also shows successful DMEK exchange after mycobacterial interface infection is possible. This case was presented on the ESCRS winter meeting as well. Now with longer follow-up (antibiotic therapy completely stopped).

Financial Disclosure:

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