Abstract

77-y/o diabetic male underwent right eye DSAEK for PBK, with long-standing peripheral corneal vascularization and scar. At 3 months post-surgery, he developed an inferior corneal epithelial defect with infiltrate, potentially infective or related to healing issues. A geographical ulcer pattern with underlying stromal infiltrate was seen on fluorescein stain, leading to a diagnosis of herpetic epithelial-stromal keratitis. He responded well to oral Acyclovir and continued prophylaxis with oral Acyclovir and topical steroids. After 6 months, he showed signs of graft rejection that didn't respond to treatment. 4 months later, he presented with a central corneal ulcer and hypopyon with Gram-positive cocci on corneal scraping. Treatment involved topical Levofloxacin 1.5% and cycloplegics, with discontinued topical steroids, resulting in healing and a central full-thickness corneal scar. Etiologies, predisposing factors, and management options for post-DSAEK infections will be discussed.