Acute interface infectious keratitis with multidrug resistant Klebsiella and Escherichia Coli following deep anterior lamellar keratoplasty

Acute interface infectious keratitis (AIIK) is a rare and devastating complication following lamellar keratoplasty. Here, we report a case of AIIK following deep anterior lamellar keratoplasty (DALK) caused by double gram-negative bacilli and required urgent therapeutic penetrating keratoplasty (TPK). Microbiology revealed co-infection with Klebsiella and E. Coli sensitive only to colistin. Donor rim culture also grew Klebsiella. TPK was successful in controlling the infection and the patient responded to topical fortified amikacin and ciprofloxacin. Since optical quality tissue was used, the patient regained 20/40 vision postoperatively. This report highlights that immediate TPK and intense antimicrobial therapy can salvage these eyes with good visual outcome.