title: Early-Onset Candida glabrata Interface Keratitis after Deep Anterior Lamellar Keratoplasty.
abstract: OBJECTIVE
  Fungal interface keratitis by Candida species can occur several weeks to several months after deep anterior lamellar keratoplasty (DALK). Here, we report a case of early-onset fungal interface keratitis by Candida glabrata after DALK.
  
  
  METHODS
  A 31-year-old Chinese man complained of decreased vision 4 days after an uneventful DALK for keratoconus. White to cream-colored interface deposits were identified under slit-lamp examination. The confocal scan disclosed clusters of hyperreflective granular deposits of 2 to 4 μm at the interface, without evidence of inflammation or hyphae-like structures. The graft was then removed, along with interface irrigation, and another graft was sutured. Finally, a penetrating keratoplasty was performed because the interface opacities recurred and deteriorated after graft replacement. Histopathological examination disclosed yeast-like structures at the retrocorneal side. The microbiologic results of both corneal scrapings taken from the recipient stromal bed and the removed half cornea button showed C. glabrata.
  
  
  CONCLUSIONS
  Candida glabrata interface keratitis can occur early after DALK, which can only be effectively treated with penetrating keratoplasty. Confocal microscopy is a promising tool to diagnose this rare complication. The importance of donor corneoscleral rim cultures should be emphasized during DALK.
authors.affiliation: *MD, PhD †MD Department of Ophthalmology (QL, DW, YL, JX), Research Center (QL), Myopia Key Laboratory of Ministry of Health (QL, DW, JX), Department of Clinical Laboratory (JJ), and Department of Pathology (RC), Eye and ENT Hospital of Fudan University, Shanghai, China.
authors.forename: Qihua
authors.initials: Q
authors.lastname: Le
authors.forename: Dan
authors.initials: D
authors.lastname: Wu
authors.forename: Yimin
authors.initials: Y
authors.lastname: Li
authors.forename: Jian
authors.initials: J
authors.lastname: Ji
authors.forename: Rongrong
authors.initials: R
authors.lastname: Cai
authors.forename: Jianjiang
authors.initials: J
authors.lastname: Xu
mesh_terms: D000328:Adult; D041221:Candida glabrata / Q000302:isolation & purification*; D002177:Candidiasis / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery; D003319:Corneal Stroma / Q000382:microbiology / Q000473:pathology; D016039:Corneal Transplantation / Q000009:adverse effects*; D003320:Corneal Ulcer / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery; D006801:Humans; D007640:Keratoconus / Q000601:surgery*; D015948:Keratoplasty, Penetrating; D008297:Male; D018613:Microscopy, Confocal; D012086:Reoperation; D041623:Tomography, Optical Coherence