Infectious Crystalline Keratopathy

Infectious Crystalline Keratopathy

Category(ies): Cornea

Contributor: Lauren E. Hock, MD and Mark A. Greiner, MD

Photographer: Antoinette Venckus, CRA; Photomicrographs by Nasreen Syed, MD

This 73-year-old male patient presented to the Cornea service with a one-week history of right eye redness and pain. He had a remote history of open globe with multiple subsequent penetrating keratoplasties and a recent macula-involving retinal detachment all in the right eye with resulting hand motions vision. He was diagnosed with suture-related infectious crystalline keratopathy with associated epithelialized stromal melt. The dense crystals seen within the deep stroma represent arborizing aggregates of an infectious agent, often alpha-hemolytic streptococcus or Candida albicans, and often originating from a suture track. Microbial colonies proliferate within stromal lamellar spaces and are shielded by a biofilm [1]. Corneal cultures are often negative. Lack of host inflammatory response may be due to chronic immunosuppression, tear film irregularity, or suture [2].

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Contributor: Matt Ward, MD

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This 73-year-old male patient presented to the Cornea service with a one-week history of right eye redness and pain. He had a remote history of open globe with multiple subsequent penetrating keratoplasties and a recent macula-involving retinal detachment all in the right eye with resulting hand motions vision. He was diagnosed with suture-related infectious crystalline keratopathy with associated epithelialized stromal melt. The dense crystals seen within the deep stroma represent arborizing aggregates of an infectious agent, often alpha-hemolytic streptococcus or Candida albicans, and often originating from a suture track. Microbial colonies proliferate within stromal lamellar spaces and are shielded by a biofilm [1]. Corneal cultures are often negative. Lack of host inflammatory response may be due to chronic immunosuppression, tear film irregularity, or suture [2].

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Contributor: Andrew Doan, MD, PhD

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Infectious crystalline keratopathy in corneal transplant graft. Often strep viridans is the culprit.

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Reference:

• Porter AJ, Lee GA, Jun AS. Infectious crystalline keratopathy. Surv Ophthalmol 2018;63(4):480-499. https://PubMed.gov/29097211. DOI: 10.1016/j.survophthal.2017.10.008
• Mannis MJ, Holland EJ. Cornea. Fourth edition. ed.

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