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Interface infectious keratitis after anterior and posterior lamellar keratoplasty. Clinical features and treatment strategies. A review
  1. Luigi Fontana1,
  2. Antonio Moramarco1,
  3. Erika Mandarà1,
  4. Giuseppe Russello2,
  5. Alfonso Iovieno1,3
  1. 1 Ophthalmology Unit, Azienda USL – IRCCS di Reggio Emilia, Reggio Emilia, Italy
  2. 2 Microbiology Unit, Azienda USL – IRCCS di Reggio Emilia, Reggio Emilia, Italy
  3. 3 Department of Ophthalmology and Visual Science, University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Luigi Fontana, Ophthalmology Unit, Azienda USL – IRCCS di Reggio Emilia, Reggio Emilia 42010, Italy; luifonta{at}


Interface infectious keratitis (IIK) is a novel corneal infection that may develop after any type of lamellar keratoplasty. Onset of infection occurs in the virtual space between the graft and the host where it may remain localised until spreading with possible risk of endophthalmitis. A literature review identified 42 cases of IIK. Thirty-one of them occurred after endothelial keratoplasty and 12 after deep anterior lamellar keratoplasty. Fungi in the form of Candida species were the most common microorganisms involved, with donor to host transmission of infection documented in the majority of cases. Donor rim cultures were useful to address the infectious microorganisms within few days after surgery. Due to the sequestered site of infection, medical treatment, using both topical and systemic antimicrobials drugs, was ineffective on halting the progression of the infection. Injection of antifungals, right at the graft–host interface, was reported successful in some cases. Spreading of the infection with development of endophthalmitis occurred in five cases after Descemet stripping automated endothelial keratoplasty with severe sight loss in three cases. Early excisional penetrating keratoplasty showed to be the treatment with the highest therapeutic efficacy, lowest rate of complications and greater visual outcomes.

  • keratitis
  • corneal interface infection
  • deep anterior lamellar keratoplasty
  • endothelial keratoplasty
  • endophthalmitis

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  • Contributors LF contributed to the literature review, data collection and paper writing. EM contributed to the literature review and data collection. AM, GR and AI contributed to the paper writing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer Authors of this paper have nothing to disclose in relation to this article. No funding was received for the publication of this article.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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