Purpose:

To report the case of a late-onset fungal keratitis two months after a penetrating keratoplasty (PKP).

Case:

A 24-year-old male underwent a PKP on his left eye for advanced keratoconus, without complications. Two months later, corneal infiltrates were apparent and empiric treatment was initiated. As corneal infiltrates progressed, two corneal cultures and a corneal biopsy were performed, all negative. A second corneal biopsy was performed, reporting Candida glabrata. The keratitis was successfully treated with topical, intrastromal and intracameral injections of amphotericin B. Posterior neovascularization of the corneal graft was treated with intrastromal and subconjunctival injections of anti-vascular endothelial growth factor. A second PKP was performed and a secondary cataract developed and was removed. Two years later the patient still has a corrected distance visual acuity of 20/20 in his left eye.

Conclusion:

This case shows the importance of corneal biopsy and an aggressive therapy in cases of recalcitrant keratitis after a PKP.