The authors report two cases of interface fungal keratitis following Descemet's stripping automated endothelial keratoplasty (DSAEK). Two patients developed culture-proven interface keratitis with Candida albicans and Candida glabrata following DSAEK. Both patients presented with white interface opacities at approximately 1 month after uncomplicated DSAEK. Adjunct confocal microscopy identified fungal elements prior to surgical therapy. A penetrating keratoplasty was performed in both cases after failed medical therapy with fungal elements confirmed by corneal histopathology. Interface fungal keratitis must be recognized as a potential complication of endothelial keratoplasty. Surgeons should consider corneal donor rim cultures on all endothelial keratopathy cases and confocal microscopy on cases with new interface opacities in the early postoperative period. These measures may lead to early identification and treatment of fungal interface infections.

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Purpose: To evaluate the effect on donor rim cultures and postoperative infections of doubling the povidone-iodine exposure time during corneal tissue recovery before its use in keratoplasty. Methods: Consecutive donor cornea recoveries were evaluated for positive donor corneal rim cultures and postoperative infections before and after a protocol change of doubling the exposure time of povidone-iodine during donor preparation. Results: In 631 consecutive cornea donor recoveries, 18 (2.9%) had positive fungal rim cultures and 41 (6.5%) had positive bacterial rim cultures. Three (0.48%) developed postoperative fungal infections, and no bacterial infections occurred. After doubling the povidone-iodine exposure time during the recovery process, 725 consecutive corneas were reviewed. Four (0.6%) had positive fungal rim cultures, and 29 (4.0%) had positive bacterial rim cultures. No postoperative fungal or bacterial infections occurred. No noticeable increase in epithelial toxicity developed between the 2 groups. Conclusions: Increasing the povidone-iodine exposure time during the donor cornea recovery process decreased the rate of positive donor corneal rim fungal cultures (P = 0.001), positive donor corneal rim bacterial cultures (P = 0.04), and postoperative fungal infections (P = 0.06).

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