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Letter to the Editor
Unsuspected infectious crystalline keratopathy masquerading as corneal graft rejection
  1. DANNY A MORRISON,
  2. GERRY T FAHY
  1. Department of Ophthalmology, Leicester Royal Infirmary NHS Trust, Leicester LE1 5WW
  2. Department of Histopathology, Leicester Royal Infirmary NHS Trust, Leicester LE1 5WW
  1. LAURENCE J R BROWN
  1. Department of Ophthalmology, Leicester Royal Infirmary NHS Trust, Leicester LE1 5WW
  2. Department of Histopathology, Leicester Royal Infirmary NHS Trust, Leicester LE1 5WW
  1. Mr D A Morrison, Department of Clinical Genetics, Molecular Medicine Centre, Western General Hospital, Crewe Road, Edinburgh EH4 2XU.

https://doi.org/10.1136/bjo.81.7.608

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    Editor,—Infectious crystalline keratopathy (ICK) is a condition in which there is a chronic and insidious non-inflammatory bacterial infiltration of the cornea. It is thought to have the distinct appearance of snowflake-like branching crystals on slit-lamp examination. We present a case of ICK occurring in a corneal graft which presented with the signs of graft rejection. ICK was not suspected clinically, but was diagnosed by histological examination of the failed graft.

    CASE REPORT

    A fit 90-year-old woman underwent uneventful left extracapsular cataract extraction, posterior chamber lens (PMMA) implantation, and penetrating keratoplasty using an organ cultured cornea, for bullous keratopathy secondary to Fuchs’ endothelial dystrophy.

    Postoperatively, prednisolone eyedrops 1%, 2 hourly and chloramphenicol eyedrops were administered. A large epithelial defect had disappeared by day 5, when she was discharged home. At 1 month there was diffuse superficial punctate erosions on the graft epithelium and an excessive number of unexplained stromal folds persisted. Treatment was changed …

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