PMC5848353_01
(a) Auro K pro (b) clearly visible posterior pole (c) infiltrates at back of carrier graft 6-weeks postoperatively (d) fluffy deposits on keratoprosthesis stem (e) increasing infiltrates after 3 days of antifungal therapy (f) development of vitritis (g) vitreous tap polymerase chain reaction positive for panfungal genome (h) dotted line represents site of intrastromal injection of amphotericin B for confluent infiltrates (i and j) decreasing infiltrates after intravitreal and intrastromal amphotericin B (k) amniotic membrane graft for nonhealing epithelial defect (l) closed funnel retinal detachment at the last follow-up
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F1
After obtaining informed consent, primary implantation of an aphakic Auro K Pro (+61.5 dioptres) was done with an initial uncomplicated course [Figure 1a and b] on a postoperative regimen of topical vancomycin (5%), moxifloxacin (0.5%), prednisolone acetate (1%), and 1% carboxymethyl cellulose each instilled 6 times/day. Deep stromal infiltrates in the carrier graft [Figure 1c], and fluffy deposits on the back of the keratoprosthesis stem, along with a missing bandage contact lens and presence of an epithelial defect were noted [Figure 1d]. Three days later, BCVA had deteriorated to 20/400 and infiltrates in the corneal stroma and on the stem of the K Pro optic had increased [Figure 1e] along with development of vitritis [Figure 1f]. Polymerase chain reaction of the vitreous sample was strongly positive for a panfungal genome [Figure 1g, lane no 2, sample no 537]. Due to lack of significant resolution of the colonies at back of optic stem and increasing confluence of the corneal infiltrates [Figure 1h], amphotericin B 5 mug/0.1 ml was repeated intravitreally after 72 h and was also injected intrastromally into the carrier graft around the edge of the infiltrates [Figure 1h-dotted line] after corneal scrapings had been taken for Gram stain and KOH wet mount (both of which later returned negative results). Over the course of the next 2 weeks, the colonies at the back of the optic stem and the infiltrates in the corneal stroma of the carrier graft started resolving [Figure 1i and j]. Cryopreserved amniotic membrane was applied subsequently to deal with a persistent 360  epithelial defect on the carrier graft [Figure 1k]. However, he missed a scheduled follow-up and 4 months later reported with decreased visual acuity when he was detected to have developed an inoperable closed funnel retinal detachment [Figure 1l].