Abstract

GRAFT SURVIVAL FOLLOWING STREPTOCOCCUS PNEUMONIAE KERATITIS AFTER DEEP ANTERIOR LAMELLAR KERATOPLASTY(DALK)

*Dr. Hilda K. Nixon, Dr. Lilan Bhat and Dr. David Pudukadan

Abstract

Interface infectious keratitis (IIK) between the donor and host corneas following lamellar keratoplasty is a rare devastating complication. A 16 yr old male patient, referred from outside, with painless dimension of vision both eyes(left eye more than right eye). Clinical findings and ASOCT topography revealed left eye advanced keratoconus. He had underwent DALK for left eye. Subsequently at 6 months follow up, graft was clear with intact sutures. 3 months later he had foreign body sensation of left eye for 2 weeks. He had Dense full thickness graft infiltrate. A loose suture was noted. Corneal scraping report showed streptococcus pneumonia. Aggressive topical and oral antimicrobials(based on culture sensitivity report) initiated immediately. Contrary to our expectation, patient had surprisingly improved clinically on daily basis and the need for Therapeutic keratoplasty/ regraft was not required. In our case, the loose might have triggered graft infection. Timely recognition of loose sutures and prompt treatment is mandatory to prevent devastating complications like rejection and failure.

Keywords: Interface infectious keratitis, deep anterior lamellar keratoplasty, endophthalmitis, loose suture, graft infiltrate.