Intrastromal antifungal injection with secondary lamellar interface infusion for late-onset infectious keratitis after DSAEK

Purpose: The aim of this study was to report the successful medical management of 2 cases of late-onset endothelial keratoplasty-related stromal interface infections. Methods: All cases of endothelial keratoplasty-related infections treated with intrastromal antifungal injections were compiled. The following information was collected: demographic data, surgical indications, donor rim cultures, donor mate outcomes, clinical course, diagnostic tests, and clinical outcome. Results: Two cases of interface fungal keratitis diagnosed on clinical appearance and confocal microscopy were identified. Both patients refused to undergo further surgery and failed systemic and/or topical therapy. Each received 3 to 4 intrastromal injections, with secondary infusion into the graft-host interface, which resulted in the complete involution of their interface opacities. Conclusions: Intrastromal antifungal injection may be an effective alternative to surgical intervention in late-onset fungal Descemet stripping endothelial keratoplasty interface keratitis. Early treatment may preserve graft viability and result in a good visual outcome without the need for either penetrating keratoplasty or potential pathogen exposure to the anterior chamber.