Infectious crystalline keratopathy following Descemet's stripping automated endothelial keratoplasty

We describe this first case of Staphylococcus epidermidis causing infectious crystalline keratopathy (ICK) following Descemet stripping endothelial keratoplasty (DSAEK), that resolved after 5 weeks of topical antibiotic and corticosteroid treatment. An 80-year-old woman presented with blurred vision, redness, and ocular pain 9 months after successful DSAEK. Slit lamp examination revealed the presence of white, non-suppurative, deep-branching stromal infiltrates, and a clinical diagnosis of ICK was made. Cultures of corneal scapings isolated multidrug-resistant Staphylococcus epidermidis. No subsequent surgical procedures were performed. Based on antibiotic sensitivity analysis, she was treated successfully with topical vancomycin and chloramphenicol for 5 weeks. Complete resolution of the infection with minor anterior stromal corneal scarring of the host cornea was noted after 5 weeks of treatment. This case report describes the diagnosis and management of ICK after DSAEK and reviews the relevant literature regarding the occurrence of ICK after DSAEK. In this case, vancomycin and chloramphenicol allowed for the uncomplicated resolution of infection with only minor visual impairment from baseline.