Infectious Crystalline Keratopathy Caused by Diphtheroids Treated with Intrastromal Antibiotics in a Post-corneal Transplant Patient

Purpose: To present a case of infectious crystalline keratopathy caused by Diphtheroids in a post-corneal transplant patient.

Design: Prospective, interventional case report.

Case Report: This is a case of a 44 year-old male seen at a tertiary hospital in Manila, Philippines. He underwent penetrating keratoplasty of the right eye 5 years prior to present consult for a corneal scar secondary to trauma sustained in childhood. Three years after the initial surgery, patient suffered another blunt trauma incident, causing graft dehiscence, and eventually necessitating graft re-suturing. In the interim, he experienced recurrent eye redness, to which he self-medicated with topical corticosteroids. Non-resolution of symptoms prompted the present consult.

Methodology/Results: The patient consulted 9 months after the second surgery. Initial examination revealed an intact corneal epithelium, with white branching needle-like infiltrates located from the anterior to midstroma of the corneal graft. Culture of the corneal scraping was done, which revealed growth of Diphtheroids. Moxifloxacin was injected intrastromally. Topical corticosteroid was discontinued and topical Moxifloxacin was started. After 1 month of therapy, the infiltrates were eradicated and a vascularized scar developed on the graft.

Conclusion: Diphtheroids can be a causative organism of infectious crystalline keratopathy, with a clinical presentation similar to those caused by Gram positive cocci. Intrastromal antibiotic injection and discontinuation of topical corticosteroids are essential in the treatment of this condition.