Our Summary

This study looked at how often a specific type of fungal eye infection, called Candida keratitis, occurred after corneal transplants in India. Out of 789 patients, 31 developed a graft infection after their corneal transplant, and of these, only 5 were found to have Candida keratitis. The researchers found that the risk factors for this infection included having a second corneal transplant, using topical steroids for a long time, and having defects in the outer layer of the cornea. The infection showed up in different ways, including as powdery deposits, white plaque, fluffy white infiltrate, and crystalline keratopathy (a condition where crystal-like substances accumulate in the cornea). All five cases showed evidence of the fungus under the microscope, while four out of five cases grew the fungus in culture. The outcomes of the treatment, which included both systemic (taken by mouth or injection) and topical (applied to the eye) antifungal medications, varied. Two patients had to have their eyes removed, two developed scars in the transplanted cornea, and one patient died from their systemic disease a month after the corneal infection was detected. The researchers concluded that Candida keratitis is becoming more common in India following corneal transplantation, and although the outcomes can be serious, the infection can be prevented by addressing the risk factors in a timely manner.

FAQs

  1. What is Candida keratitis and how common is it after corneal transplants in India?
  2. What are the risk factors associated with Candida keratitis following a corneal transplant?
  3. What are the potential outcomes for patients who develop Candida keratitis after a corneal transplant?

Doctor’s Tip

A doctor might tell a patient about the importance of following post-operative care instructions closely, including using prescribed medications as directed and attending all follow-up appointments. They may also advise the patient to report any symptoms of infection, such as redness, pain, or vision changes, immediately. Additionally, the doctor may discuss the importance of minimizing the use of topical steroids and avoiding any factors that may increase the risk of infection, such as a second corneal transplant or having defects in the cornea. Overall, the doctor would stress the importance of proactive management and early intervention in preventing and treating potential infections following a corneal transplant.

Suitable For

Patients who are typically recommended for corneal transplant include those with conditions such as:

  1. Keratoconus
  2. Fuchs’ dystrophy
  3. Corneal scarring from injury or infection
  4. Corneal thinning or ulceration
  5. Corneal degeneration
  6. Complications from previous eye surgeries
  7. Corneal swelling or edema
  8. Corneal dystrophies
  9. Corneal infections that do not respond to other treatments

It is important for patients to be evaluated by an ophthalmologist to determine if they are a good candidate for a corneal transplant and to discuss the potential risks and benefits of the procedure.

Timeline

  • Before corneal transplant: The patient undergoes a thorough eye examination and evaluation to determine if they are a suitable candidate for a corneal transplant. They may have to wait on a transplant list until a suitable donor cornea becomes available. During this time, they may experience vision loss, discomfort, and other symptoms related to their underlying corneal condition.

  • Day of corneal transplant: The patient undergoes the surgical procedure to replace their damaged or diseased cornea with a healthy donor cornea. The surgery is typically performed under local anesthesia and may take a few hours to complete.

  • After corneal transplant: The patient is monitored closely in the days and weeks following the surgery to ensure proper healing and to watch for any signs of complications. They may experience discomfort, light sensitivity, blurred vision, and fluctuating vision during the initial recovery period.

  • Months to years after corneal transplant: The patient continues to be monitored regularly by their ophthalmologist to assess the health and function of the transplanted cornea. They may need to take immunosuppressive medications to prevent rejection of the donor cornea. Over time, they may experience improved vision and reduced symptoms related to their corneal condition.

  • Post-infection: If a patient develops a post-transplant infection like Candida keratitis, they may experience symptoms such as pain, redness, decreased vision, and discharge from the eye. Treatment typically involves a combination of systemic and topical antifungal medications to eradicate the infection. The outcome of treatment can vary, with potential complications including corneal scarring, vision loss, and in severe cases, the need for eye removal. Regular follow-up care is essential to monitor the patient’s progress and prevent future infections.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a corneal transplant, including the risk of fungal infections like Candida keratitis?

  2. What are the risk factors for developing fungal infections after a corneal transplant, and how can they be managed or minimized?

  3. How often will I need to follow up with you after the corneal transplant to monitor for any signs of infection or complications?

  4. What symptoms should I watch out for that may indicate a fungal infection following a corneal transplant, and when should I seek medical attention?

  5. What is the treatment protocol for Candida keratitis or other fungal infections that may occur after a corneal transplant, and what are the potential outcomes of treatment?

  6. Are there any preventative measures or medications that can be taken to reduce the risk of developing a fungal infection after a corneal transplant?

  7. How common is Candida keratitis or other fungal infections following corneal transplants in your practice, and what steps do you take to prevent and manage these infections?

Reference

Authors: Sati A, Wagh S, Mishra SK, Kumar SV, Kumar P. Journal: Indian J Ophthalmol. 2022 Feb;70(2):536-541. doi: 10.4103/ijo.IJO_560_21. PMID: 35086233