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    Fungal infections after keratoplasty on upswing

    Consider pearls for better diagnosis, management; weigh risk/benefit of surgical intervention

    Los Angeles—Infections after keratoplasty—particularly Descemet stripping endothelial keratoplasty (DSEK)—are on the rise, with the majority of cases being fungal, said Anthony Aldave, MD.

    A report from the Eye Bank Association of America (EBAA) identified an increasing trend in the incidence of fungal infections after corneal transplantation between 2005 and 2010.1

    Recent: Why infections related to PK require intense vigilance

    A recently conducted follow-up study has confirmed a significant increase in the incidence of post-keratoplasty fungal infection.

    In addition, “the risk is significantly higher following DSEK than penetrating keratoplasty [PK],” said Dr. Aldave, professor of ophthalmology, Walton Li Chair in Cornea and Uveitis, chief, Cornea and Uveitis Division, and director, Cornea and Refractive Surgery Fellowship, Stein Eye Institute, University of California, Los Angeles.

    Research from the EBAA found that two-thirds of all infections were due to fungi, and almost all of those were Candida species.

    Related: Addressing challenges of Acanthamoeba keratitis

    The diagnosis of post-keratoplasty interface infections most often occurs 3 to 16 weeks after surgery. The usual signs are focal interface opacities that slowly increase in size and number, Dr. Aldave said.

    “Imaging with confocal microscopy to identify the presence of fungi can be very helpful to diagnose the cause,” he said.

    An anterior chamber tap can be performed as well, but would likely be negative if the organisms are confined to the donor-host interface following DSEK or Descemet membrane endothelial keratoplasty (DMEK).

    More: Prompt attention vital to managing severe corneal infections

    Biopsy is another option, although excision of a portion of the donor cornea is probably easier with cases of DMEK than DSEK, he added.

    In terms of management, corneal rim cultures that are positive can be helpful to guide therapy, Dr. Aldave advised.

    Surgeons should also find out about the mate cornea (the fellow eye donor cornea) to determine if donor corneal rim cultures were performed and whether the recipient developed an infection.

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