Descemet’s stripping endothelial keratoplasty in a case of fungal keratitis: A targeted approach to visual recovery

This is a case of fungal keratitis managed successfully with intrastromal antifungal injections followed by Descemet’s stripping endothelial keratoplasty (DSEK) for visual rehabilitation. A 45-year-old man with a history of trauma to the eye with vegetative matter presented with a clinical picture of a central corneal infiltrate at the level of posterior stroma with multiple satellite lesions in the superior quadrant. Since the infiltrate was deep in the posterior stroma and over the endothelium, confocal microscopy followed by endoscraping was performed. Confocal microscopy revealed multiple filamentous structures at deeper corneal stromal sections. The smear examination from endoscraping showed the presence of septate hyaline fungal filaments on Gram’s staining and KOH-calcofluor white stain. The lesion responded to topical and intrastromal amphotericin B and healed with a retro-corneal membrane and a decompensated cornea, for which he later underwent DSEK for visual rehabilitation.