Objective:

To report a case of interface keratitis caused by Candida after deep anterior lamellar keratoplasty (DALK) with small lesions, treated with early penetrating keratoplasty.

Observations:

The case is about a 37-year-old male treated with DALK on his right eye for keratoconus. Few days after the procedure, the donor rim culture was positive for Candida. Prophylaxis did not prevent the development of infection after three months. Topical and systemic antifungal therapy was not effective. Despite the small size of the lesions, we performed penetrating keratoplasty (PK). Microbiologic and histopathologic reports confirmed Candida glabrata interface keratitis. Six months after PK, the cornea remains clear with a best-corrected visual acuity of 20/30.

Conclusions and importance of the case:

Our case shows that early PK, despite the small size of the lesions, improves outcomes in Candida interface keratitis after DALK. A positive donor rim culture is useful for early decision making.