Abstract

Volume.125 Number.4

Original article : Case report

An Example of Detection of a Yeast-like Fungus from a White Nodule Found on the Posterior Surface of the Cornea Following Descemet Stripping Automated Endothelial Keratoplasty
Akira Minamoto1, Ryotaro Toda1, Taiichiro Chikama1, Sousuke Inokawa2, Kaori Mitoma1, Yoshiaki Kiuchi1
1 Department of Ophthalmology and Visual Science, Graduate School of Biomedical and Health Sciences, Hiroshima University
2 Inokawa Eye Clinic

Purpose: To report a case of endophthalmitis occurring approximately 2 months after corneal endothelial transplant, presenting a white-colored nodule on the posterior surface of the cornea.
Case report: A 80-year-old female was seen at a local eye clinic in November 2014 requesting cataract surgery. She was referred to our department (Hiroshima University Hospital, Department of Ophthalmology and Visual Science) for examination and medical treatment due to low corneal endothelial cell density in both eyes. In May 2017, she experienced prolonged corneal edema following cataract surgery on her right eye, and in June 2017 she underwent corneal endothelial transplant surgery. Her postoperative course was good with continued use of moxifloxacin and betamethasone phosphate eye drops. In September 2017, she suddenly experienced reduced visual field, mild hyperemia, and eye pain. Intraocular inflammation was confirmed by re-examination at a nearby clinic. She received treatment of intravenous infusion of cefoperazone-sulbactam, dexamethasone, fluconazole and fluconazole eye drops, but as hypopyon was observed, she was again referred to our department. There was mild conjunctival hyperemia and severe intraocular inflammation and there was a white nodule on the posterior surface of the cornea. After collecting the white nodule with a 24 G Surflo needle in the operating room, we performed an anterior chamber irrigation. A large quantity of yeast-like fungus was observed by direct smear examination of the white nodule. We diagnosed fungal keratitis localized to the graft and treatment with intravenous infusion of voriconazole, fluconazole and moxifloxacin eye drops improved the symptoms. The results of the culture test identified Candida glabrata. Relapse did not occur following the anterior chamber irrigation, and the postoperative progress was good.
Conclusion: In the case of fungal conjunctivitis localized to the transplant following corneal endothelial transplant surgery, direct microscopic smear examination of the white nodule on the posterior corneal surface was beneficial for early diagnosis and treatment.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 125: 452-458, 2021.

Key words
Descemet stripping automated endothelial keratoplasty, Fungal infection, White nodule on the posterior corneal surface, Fungus ball, Candida glabrata
Reprint requests to
Akira Minamoto, M. D. Department of Ophthalmology and Visual Science, Graduate School of Biomedical and Health Sciences, Hiroshima University. 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan