BMJ Case Reports 2017; doi:10.1136/bcr-2017-220464
  • Unusual association of diseases/symptoms

Infectious crystalline keratopathy after Descemet’s stripping endothelial keratoplasty

  1. Kevin Whitehead4
  1. 1City Eye Centre, Brisbane, Queensland, Australia
  2. 2University of Queensland, Brisbane, Queensland, Australia
  3. 3Mater Health Services, Brisbane, Queensland, Australia
  4. 4Sullivan & Nicolaides Pathology, Brisbane, Queensland, Australia
  1. Correspondence to Graham A Lee, mdglee{at}
  • Accepted 30 May 2017
  • Published 14 June 2017


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 Enterococcus faecalis 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.


  • Contributors All authors meet the criteria for authorship. GAL was involved in the conceptual design, drafting and editing the article. AJP was involved in case data acquisition and drafting the article. KW was involved in case data interpretation. All authors were in agreement for approval of the article for publishing and to ensure that the article is accurate.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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