Infectious crystalline keratopathy: an electron microscope analysis.

A 73-year-old man developed a crystalline stromal keratopathy in one eye following his second corneal transplant. Despite aggressive treatment with antibiotics and antifungal agents, the lesion increased in size. A corneal transplant was performed and histopathologic studies were performed using both light and transmission electron microscopy. The characteristic trilamellar structure of a bacterial cell wall was found. The organisms were present only anteriorly. Small electron-dense bodies with needle-like projections were found. These bodies may be responsible for the crystalline appearance of this keratopathy. The appearance of a crystalline keratopathy should alert clinicians to the possibility of a low-grade bacterial infection. After appropriate cultures, we advise early and aggressive therapy with appropriate antibiotics.