Case Report of Candida Parapsilosis Keratitis After Cataract Surgery Leading to Corneal Perforation

Abstract

The objective of this study was to report and document a rare case of Candida parapsilosis keratitis that occurred following a routine clear corneal incision cataract surgery, ultimately resulting in a perforated corneal ulcer and subsequent need for a penetrating keratoplasty (PK). By presenting this case, the study aims to contribute to the existing literature and raise awareness about the potential risk of C. parapsilosis keratitis as a complication of cataract surgery. In this case report, we describe the presentation and management of a rare fungal infection following routine cataract extraction in an 80-year-old male patient. The patient initially received treatment for suspected endophthalmitis and bacterial keratitis but experienced worsening symptoms, including a small corneal perforation. Upon referral to the clinic, the patient exhibited a fluffy stromal infiltrate near the cataract wound site, an epithelial defect, and a hypopyon. Treatment with compounded topical 1% voriconazole was initiated but did not prevent the progression of the corneal perforation. Attempts to seal the perforation with corneal glue were unsuccessful, leading to the decision to perform a PK. During the surgery, corneal tissue was biopsied and cultured to identify the causative agent. Following PK, the corneal cultures revealed the growth of C. parapsilosis, confirming the fungal nature of the infection. The patient was then reinitiated on topical voriconazole for a prolonged course of 7 months. Throughout this period, the patient was closely monitored and followed up in the clinic. Fortunately, there were no recurrences of the fungal lesion during this time. No prior cases of a perforated corneal ulcer resulting from C. parapsilosis keratitis after routine cataract surgery have been reported in the literature to our knowledge. Our patient experienced postoperative complications characterized by recurrent inflammation, which was treated with potent and frequent topical steroids. This treatment masked the underlying mycotic infection and contributed to corneal perforation. Ultimately, the patient underwent a successful PK procedure to remove the infectious nidus, followed by an extended 7-month course of topical voriconazole. No recurrence of the lesion was observed. Therefore, clinicians should be vigilant for mycotic keratitis, specifically C. parapsilosis, in patients who display late-onset, persistent inflammation and white plaques at the clear corneal incision site after cataract surgery. The combination of PK and an extended postoperative treatment with topical antifungal agents proves to be an effective strategy for managing corneal perforations caused by C. parapsilosis keratitis.