title: Simultaneous Interface Candida Keratitis in 2 Hosts Following Descemet Stripping Endothelial Keratoplasty With Tissue Harvested From a Single Contaminated Donor and Review of Clinical Literature.
abstract: OBJECTIVE
  The objective of this study was to report 2 cases of interface fungal keratitis in 2 separate patients following Descemet stripping automated endothelial keratoplasty (DSAEK) with tissue harvested from the same donor.
  
  
  METHODS
  This was a retrospective simultaneous interinstitutional hosptial-based case reports.
  
  
  METHODS
  Two patients with corneal infections following DSAEK were identified from 2 individual practices. Both patients had undergone DSAEK from the same donor. Preoperative and postoperative eye examination included visual acuity, anterior and posterior segment evaluations, and clinical follow-up course from the time of surgery. Methods of medical therapy and surgical intervention are additionally discussed.
  
  
  RESULTS
  The 2 patients presented in our series present with interface fungal keratitis postoperatively in the face of the original source coming from a single donor (patient 1: 7 days postoperatively and patient 2: 7 weeks postoperatively). As medical treatment failed in both cases, surgery was undertaken in both cases (therapeutic penetrating keratoplasty). With prompt recognition as well as medical and surgical treatment, patient 1 achieved best corrected visual acuity of 20/30 at 6 months postoperatively, and patient 2 had best corrected visual acuity of 20/80 at 10 months postoperatively.
  
  
  CONCLUSIONS
  Fungal keratitis following DSAEK occurs in a sequestered space and therefore represents a treatment challenge with potentially devastating outcome. We recommend an aggressive surgical approach with early removal of the donor button and irrigation with intracameral antifungal agents.
authors.affiliation: From the *Kaiser Permanente Medical Group, Santa Clara; †Gavin Herbert Eye Institute, University of California, Irvine; ‡Kaiser Permanente Medical Group, Redwood City; and §Kaiser Permanente Medical Group, Walnut Creek, CA.
authors.forename: Huck A
authors.initials: HA
authors.lastname: Holz
authors.forename: Amir
authors.initials: A
authors.lastname: Pirouzian
authors.forename: Sudha
authors.initials: S
authors.lastname: Sudesh
authors.forename: Doug S
authors.initials: DS
authors.lastname: Holsclaw
authors.forename: Naveen S
authors.initials: NS
authors.lastname: Chandra