Porter Ashley J, Lee Graham A, Whitehead Kevin
City Eye Centre, Brisbane, Queensland, Australia.
University of Queensland, Brisbane, Queensland, Australia.
BMJ Case Rep. 2017 Jun 14;2017:bcr-2017-220464. doi: 10.1136/bcr-2017-220464.
A 68-year-old woman presented with infectious crystalline keratopathy 4 months after she underwent a combined phacoemulsification and Descemet's stripping endothelial keratoplasty for Fuch's endothelial dystrophy in her left eye. After 5 months of topical moxifloxacin 1%, the infiltrate responded well but had not completely resolved, with the resulting endothelial failure requiring a penetrating keratoplasty 9 months after the initial operation. Microbiology identified with the histopathology demonstrating bacterial colonies within the graft interface. Postoperatively she developed endophthalmitis, needing vitrectomy and intravitreal antibiotics. The infection settled with no recurrence, with topical and oral antibiotics continued for 2 months. A sutured toric piggyback intraocular lens was performed 18 months postvitrectomy for graft astigmatism, achieving a best-corrected vision of 6/15.Infectious crystalline keratopathy can occur following Descemet's stripping endothelial keratoplasty, requiring long-term topical therapy and potentially leading to graft failure with the necessity for further keratoplasty.
一名68岁女性在左眼因富克斯内皮营养不良接受白内障超声乳化吸除联合Descemet膜剥除内皮角膜移植术后4个月出现感染性结晶性角膜病变。使用1%的莫西沙星滴眼液局部治疗5个月后，浸润反应良好但未完全消退，最终导致内皮功能衰竭，在初次手术后9个月需要进行穿透性角膜移植术。微生物学检查结合组织病理学检查发现移植界面内有细菌菌落。术后她发生了眼内炎，需要进行玻璃体切除术并眼内注射抗生素。感染得到控制且未复发，局部和口服抗生素持续使用2个月。玻璃体切除术后18个月，为矫正移植角膜散光植入了带缝线的环曲面背驮式人工晶状体，最佳矫正视力达到6/15。Descemet膜剥除内皮角膜移植术后可能发生感染性结晶性角膜病变，需要长期局部治疗，并可能导致移植失败，进而需要进一步的角膜移植术。
