Candida keratitis after descemet stripping and automated endothelial keratoplasty

PURPOSE: To report the donor-to-host transmission of Candida albicans after Descemet stripping and automated endothelial keratoplasty (DSAEK). METHODS: An 80-year-old woman with pseudophakic bullous keratopathy developed an infiltrate in the donor corneal lenticule after DSAEK. RESULTS: Donor corneoscleral rim cultures grew C. albicans. Gram stain of the removed corneal lenticule demonstrated budding yeast and pseudohyphae, and cultures yielded C. albicans. Despite topical and systemic antifungal therapy and therapeutic penetrating keratoplasty, the patient developed a blind painful eye and underwent enucleation. CONCLUSIONS: This case report indicates that fungal keratitis may occur from donor-to-host transmission after DSAEK. The location of the infected tissue poses diagnostic and therapeutic challenges for the surgeon.