case_images: PMC10229784_01
case_images: (A) The topography showed a paracentral corneal steepening. Sim-K readings are 67.1 D and 71.2 D on the flat and steep axes, respectively, with a corneal thinning point of 273 mm. (B) On the first postoperative day (POD), the cornea is transparent and the anterior chamber reaction is mild.
case_images: fmed-10-1110411-g001.jpg
case_images: PMC10229784_01_fmed-10-1110411-g001.jpg
case_images: fig1
case_images: Her best-corrected visual acuity was 20/400, and the preoperative topography showed Amsler-Krumeich stage IV keratoconus in the left eye (Figure 1A). The surgery had gone quite well, but to our alarm, on the first postoperative day (POD), although the cornea was clear and the anterior chamber reaction was mild, the patient developed a fever with a temperature of 39.5 C (Figure 1B).
case_images: (A) Ultrasound shows an increase in echogenicity in the vitreous cavity. (B) Clinical picture shows whitish infiltrates in the center of the graft with a small hypopyon. (C,D) Bacterial cultures of corneal scrapings and the bacterial smear confirmed the carbapenem-resistant Klebsiella Pneumoniae infection.
case_images: fmed-10-1110411-g002.jpg
case_images: PMC10229784_01_fmed-10-1110411-g002.jpg
case_images: fig2
case_images: On the second postoperative day, there was a whitish infiltrate in the center of the graft (Figure 2A), with a little hypopyon and observable vitreous opacity (Figure 2B). Bacterial and fungal cultures of corneal scrapings and aqueous humor were tested immediately and which revealed carbapenem-resistant Klebsiella pneumoniae (CRKP) (Figures 2C,D), resistant to cefazolin, vancomycin, amikacin, ofloxacin, ciprofloxacin, cefixime, moxifloxacin, chloramphenicol, tetracycline, gentamicin, and cefalexin, but be sensitive to ceftazidime and colistin.
case_images: (A) The infection was infiltrated to the cornea and anterior chamber of the host. (B,C) The day after repeat-PKP, the graft is clear and the anterior segment is quiet with low intraocular pressure and lens opacity. The ultrasound showed vitreous opacity relief. (D) Six months later, the aided vision is 20/200 with a pin hole after cataract extraction and intraocular lens implantation.
case_images: fmed-10-1110411-g003.jpg
case_images: PMC10229784_01_fmed-10-1110411-g003.jpg
case_images: fig3
case_images: Five days later, a large diameter PKP (8.75 mm donor and 8.5 mm recipient) was performed due to the extension of the infiltration to the host cornea with anterior chamber opacity (Figure 3A). The day after repeat-PKP, the clinical picture improved, with little infiltrate in the graft and exudates from the anterior chamber (Figures 3B,C). Cataract extraction and intraocular lens implantation were performed 5 months postoperatively (Figure 3D).