Infectious crystalline keratopathy

Abstract

Infectious crystalline keratopathy was first reported by Gorovoy and colleagues in 1983 when they identified bacteria colonizing a cornea after a penetrating keratoplasty. Subsequent cases have elaborated on the organisms responsible and the management outcomes. Patients present with a white or gray branching opacity originating from an epithelial defect, commonly after a penetrating keratoplasty. Local immunosuppression contributes to the quiescent nature and the limited inflammatory response associated with infectious crystalline keratopathy. Diagnosis of the infective pathogens may be difficult, with a corneal scraping often being too superficial to obtain an adequate specimen. A biofilm is present that advantages microorganism survival, reduces antibiotic bioavailability, and inhibits diagnostic microbial detection. Treatment begins with topical antimicrobials, initially broad spectrum and then targeted to microorganism sensitivity. Adjunctive therapies to enhance the efficacy of treatment include disruption of the microorganism biofilm by laser, intrastromal antibiotics, and keratectomy. In recalcitrant cases, or where corneal scarring ensues, corneal transplantation is required.

Infectious crystalline keratopathy: Management of three cases with different risk factors

“…First described by Gorovoy et al, 1 infectious crystalline keratopathy is a rare, chronic and indolent pathology in which a characteristic plaque-shape interlamellar arboriform and crystalline bacterial stromal infiltrate is observed in absence of an apparent inflammation in cornea or anterior chamber 2, 3. We present three cases of infectious crystalline keratopathy in patients with different risk factors, where a pharmacological treatment led to the disappearance of the symptoms.…”

“…Many microorganisms that cause crystalline keratopathy have been reported,2, 3, 4, 5, 6, 7, 8 although viridans-type streptococci are the most frequently isolated 3, 4, 9. The identification of Bacillus spp.…”

Crystalline Keratopathy after Epi-Off Corneal Cross-Linking: Two Case Reports

“…We used fluorochinolones as a postoperative treatment for only a week, so we do not consider this as a potential etiology for the crystalline keratopathy in our cases. The main cause for crystalline keratopathy is reported due to an infectious etiology [6]. The literature review revealed one case report of unknown infection as well as one case of Fusarium solani positive crystalline keratopathy within 3 and 4 weeks of CXL, respectively [7,8].…”

Unusual complications and corneal clearance after Descemet Membrane Endothelial Transfer in Pseudophakic Bullous Keratopathy

“…If topical and/ or intrastromal antibiotics/ antifungals are unsuccessful, Nd:YAG laser can be used to disrupt the microbial biofilm. Ultimately, patients will need to undergo keratoplasty [ 10 ].…”